Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Early Clinical Outcomes of Tricuspid Valve Repair with a Tri-Ad Annuloplasty Ring in Comparison with the Outcomes Using an MC3 Ring

  • Jung, Woohyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Choi, Jae Woong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hwang, Ho Young (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Kyung Hwan (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2017.08.21
  • Accepted : 2017.10.20
  • Published : 2018.04.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: We evaluated the early clinical outcomes of tricuspid valve annuloplasty (TAP) with the Tri-Ad annuloplasty ring for functional tricuspid regurgitation (TR). Methods: From January 2015 to March 2017, 36 patients underwent TAP with a Tri-Ad ring for functional TR. To evaluate the early clinical outcomes of TAP with the Tri-Ad ring, we conducted a propensity score-matched analysis comparing the Tri-Ad and $MC^3$ tricuspid annuloplasty rings (n=34 in each group). The follow-up duration was $11.0{\pm}7.07$ months. Results: There was 1 case of operative mortality (2.8%) and no cases of late mortality. Postoperative complications occurred in 15 patients (41%), including acute kidney injury in 6 patients (16%), bleeding requiring reoperation in 4 patients (11%), and low cardiac output syndrome in 4 patients (11%). There were no ring-related complications, such as atrioventricular block or ring dehiscence. The TR grade decreased significantly (from $2.03{\pm}1.06$ to $1.18{\pm}0.92$, p<0.01), as did the systolic pulmonary artery pressure (from $43.53{\pm}13.84$ to $38.00{\pm}9.72mm\;Hg$, p=0.03). There were no cases of severe residual TR, but moderate TR was observed in 3 patients, all of whom had severe TR preoperatively. Severe preoperative TR was also associated with moderate in the univariate analysis (p<0.01). In the propensity score-matched analysis comparing the Tri-Ad and $MC^3$ rings, there was no significant difference in early clinical outcomes. Conclusion: TAP with the Tri-Ad ring corrected functional TR effectively and provided good early clinical and echocardiographic results without ring-related complications. However, severe preoperative TR was associated with moderate or severe residual TR in the immediate postoperative period. A follow-up study is necessary to confirm the stability of this procedure.

Keywords

References

  1. McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg 2004;127:674-85. https://doi.org/10.1016/j.jtcvs.2003.11.019
  2. Jeong DS, Kim KH. Tricuspid annuloplasty using the MC3 ring for functional tricuspid regurgitation. Circ J 2010;74: 278-83.
  3. Milla F, Castillo JG, Varghese R, Chikwe J, Anyanwu AC, Adams DH. Rationale and initial experience with the Tri-Ad Adams tricuspid annuloplasty ring. J Thorac Cardiovasc Surg 2012;143(4 Suppl):S71-3. https://doi.org/10.1016/j.jtcvs.2011.11.015
  4. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16:777-802.
  5. Van de Veire NR, Braun J, Delgado V, et al. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg 2011;141:1431-9. https://doi.org/10.1016/j.jtcvs.2010.05.050
  6. Ton-Nu TT, Levine RA, Handschumacher MD, et al. Geometric determinants of functional tricuspid regurgitation: insights from 3-dimensional echocardiography. Circulation 2006;114:143-9. https://doi.org/10.1161/CIRCULATIONAHA.106.611889
  7. Minato N, Itoh T. Direct imaging of the tricuspid valve annular motions by fiberoptic cardioscopy in dogs with tricuspid regurgitation: II. does flexible ring annuloplasty preserve the annular motions? J Thorac Cardiovasc Surg 1992;104:1554-60.
  8. Izutani H, Nakamura T, Kawachi K. Flexible band versus rigid ring annuloplasty for functional tricuspid regurgitation. Heart Int 2010;5:e13.
  9. Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg 2010;139:1473-82. https://doi.org/10.1016/j.jtcvs.2010.02.046
  10. Pfannmuller B, Doenst T, Eberhardt K, Seeburger J, Borger MA, Mohr FW. Increased risk of dehiscence after tricuspid valve repair with rigid annuloplasty rings. J Thorac Cardiovasc Surg 2012;143:1050-5. https://doi.org/10.1016/j.jtcvs.2011.06.019
  11. Fukuda S, Gillinov AM, McCarthy PM, Matsumura Y, Thomas JD, Shiota T. Echocardiographic follow-up of tricuspid annuloplasty with a new three-dimensional ring in patients with functional tricuspid regurgitation. J Am Soc Echocardiogr 2007;20:1236-42. https://doi.org/10.1016/j.echo.2007.03.006
  12. Fukuda S, Gillinov AM, McCarthy PM, et al. Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation 2006;114(1 Suppl): I582-7.
  13. Min SY, Song JM, Kim JH, et al. Geometric changes after tricuspid annuloplasty and predictors of residual tricuspid regurgitation: a real-time three-dimensional echocardiography study. Eur Heart J 2010;31:2871-80. https://doi.org/10.1093/eurheartj/ehq227
  14. Kim HK, Kim YJ, Kim KI, et al. Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time. Circulation 2005;112(9 Suppl):I14-9.
  15. Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg 2008;34: 908-10. https://doi.org/10.1016/j.ejcts.2008.07.006
  16. Lai YQ, Meng X, Bai T, Zhang C, Luo Y, Zhang ZG. Edge-to-edge tricuspid valve repair: an adjuvant technique for residual tricuspid regurgitation. Ann Thorac Surg 2006;81:2179-82. https://doi.org/10.1016/j.athoracsur.2006.01.046