A comparative analysis between ring annuloplasty and de vega annuloplasty in functional tricuspid regurgitation

Authors

  • Jai Bhagwan Department of Cardio-thoracic and Vascular Surgery, PGIMER and Dr. RML Hospital, New Delhi, India
  • Soumya Guha Department of Cardio-thoracic and Vascular Surgery, PGIMER and Dr. RML Hospital, New Delhi, India
  • Anubhav Gupta Department of Cardio-thoracic and Vascular Surgery, PGIMER and Dr. RML Hospital, New Delhi, India
  • Ajit Kumar Padhy Department of Cardio-thoracic and Vascular Surgery, PGIMER and Dr. RML Hospital, New Delhi, India
  • Vijay Grover Department of Cardio-thoracic and Vascular Surgery, PGIMER and Dr. RML Hospital, New Delhi, India
  • Vijay Kumar Gupta Department of Cardio-thoracic and Vascular Surgery, PGIMER and Dr. RML Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20181975

Keywords:

Annuloplasty, De vega annuloplasty, Ring annuloplasty, Tricuspid regurgitation

Abstract

Background: Tricuspid valve disease frequently accompanies left side valve disease. Surgical correction of significant functional TR at the time of left side valve surgery is recommended. The current study was under taken to assess the early impact of ring annuloplasty and De Vega annuloplasty techniques in functional significant TR in a predominantly rheumatic population.

Methods: Between January 2010 and January 2014, a total 80 patients underwent surgery for functional tricuspid valve disease. Retrospective data analysis was done. The patient selection criteria were as per the institutional protocol (for all functional severe TR and moderate TR with Tricuspid Index > 21mm/m2) based on preoperative TTE (Trans-thoracic Echocardiography) findings and the type of procedure was the surgeon’s decision on table. Techniques routinely involved in the repair procedures included tricuspid prosthetic ring Annuloplasty (MC3) and De Vega suture annuloplasty. Postoperatively all the patient had routine TTE before hospital discharge (considered as immediate post op period). Follow up was present till 6 months post-operatively (in the form of another TTE and clinical data sheet) at the time of data collection for this study.

Results: There was no statistically significant difference in residual significant TR when ring annuloplasty was compared to De Vega repair. There was significant improvement in NYHA status after both ring and De Vega annuloplasty.  

Conclusions: Present study shows similar results with both the techniques of TV repair when applied to functionally significant TR in a pre-dominantly rheumatic population.

References

Antunes MJ, Barlow JB, Management of tricuspid valve regurgitation. Heart 2007;93;271-6

Tang GHL, David TE, Singh SK, Maganti MD, Armstrong S, Borger MA. Tricuspid valve repair with an annuloplasty ring results in improved longterm outcomes. Circulation. 2006;114:1577-81

Cohn LH. Tricuspid regurgitation secondary to mitral valve disease: when and how to repair. J Card Surg. 1994;9:237-41.

Ruel M, Rubens FD, Masters RG, Pipe Al, Bedard P, Mesana TG. Late incidence of persistent or recurrent heart failure in patients with mitral prosthetic valves. J Thorac Cardiovasc Surg. 2004;128:278-83.

Calafiore AM, Gallina S, Iacò AL, Contini M, Bivona A, Gagliardi M, et al. Mitral valve surgery for functional mitral regurgitation: Should moderate or more tricuspid regurgitation be treated? A propensity score analysis. Ann Thorac Surg. 2009;698-703.

Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg. 2003;75;1826-8

Dreyfus GD, Corbi PJ, Chan KMJ, Bahrami T. Secondary tricuspid regurgitation or dialation: Which should be the criteria for surgical repair?Ann Thorac Surg. 2005;79:127-32.

Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long term survival. J Am Coll Cardiol. 2004;43:405-9

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA et al. AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017; 135:e1159-95.

Jabbad HH, Elassal AA, Eldib OS. Pericardial Strip versus Ring Annuloplasty for Repair of Functional Tricuspid Regurgitation. World J Presentnal of Cardiovas Surg. 2014;4:239-44.

De Paulis R, Bobbio M, Ottino G, Donegani E, Di Rosa E, Casabona R, et al. The De Vega tricuspid annuloplasty perioperative mortality and long term follow up. J cardiovascular Surg (Torino). 1990;31:512-7.

Holper K, Haehnel JC, Augustin N, Sebening F, Surgery for tricuspid insufficiency: Long term follow up after De Vega annuloplasty. Thorac Cardiovasc Surg. 1993;41:1-8.

McCarthy PM, Bhudia SK, Rajeswaran J, Hoercher KJ, Lytle BW, Cosgrove DM et al, Tricuspid valve repair: durability and risk factors for failure. J Thorac cardiovasc Surg. 2004;127;674-85.

Fukuda S, Gillinov AM, MC Carthy PM, Stewart WJ, Song JM, Kihara T et al. Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation. 2006;114;1582-7

Rivera R, Duran E, Ajuria M, Carpentier’s flexible ring versus De vega’s annuloplasty.A prospective randomized study. J Thorac Cardiovasc Surg. 1985;89:196-203.

Matsuyama K, Matsumoto M, Sugita T, Nishizawa J,Tokuda Y,Matsuo T et al., annuloplasty and Carpentier-Edwards ring annuloplasty for secondary tricuspid regurgitation. J Heart Valves Dis. 2001;10:520-4.

Bernal JM, Ponton A, Diaz B, Llorca J, Garcia I, Sarralde A et al. Combined mitral and tricuspid valve repair in rheumatic valve disease: fewer reoperations with prosthetic ring annuloplasty. Circulation. 2010;121:1934-40.

Carrier M, Pellerin M, Guertin MC, Bouchard D, Hebert Y, Perrault LP et al. Twenty-five years’ clinical experience with repair of tricuspid insufficiency. J Heart Valve Dis. 2004;13:952-6.

Downloads

Published

2018-05-24

Issue

Section

Original Research Articles