Twenty-five years' clinical experience with repair of tricuspid insufficiency.
OBJECTIVE
Tricuspid regurgitation secondary to pulmonary hypertension due to left-sided heart valve lesions is common. Here, the results are reported of 25 years' experience with three surgical techniques; the De Vega semicircular annuloplasty, the Bex flexible linear reducer, and the Carpentier-Edwards prosthetic ring annuloplasty.


METHODS
Between 1976 and 2002, 463 patients underwent 478 tricuspid annuloplasty procedures to correct valve regurgitation during associated left-sided valve surgery. Patients were followed prospectively at the Montreal Heart Institute Valve Clinic.


RESULTS
A total of 107 patients (23%) underwent the De Vega semicircular annuloplasty, 267 (58%) the Bex flexible linear reducer, and 89 (19%) the Carpentier-Edwards prosthetic ring annuloplasty. Excluding 30-day mortality, the mean 5-, 10- and 15-year patient survival was 82+/-4%, 58+/-6% and 30+/-6% respectively after the De Vega semicircular annuloplasty, 76+/-3%, 54+/-4% and 36+/-6% respectively after the Bex flexible linear reducer, and the mean five-year patient survival was 88+/-4% after the Carpentier-Edwards prosthetic ring annuloplasty (p = 0.65, for comparison of the three survival curves). The mean freedom rate from tricuspid repair failure (clinical right heart failure, redo annuloplasty, tricuspid valve replacement at follow up) was 95+/-3%, 93+/-3% and 72+/-8% at 5, 10 and 15 years respectively after the De Vega semicircular annuloplasty, and 97+/-1%, 87+/-4% and 66+/-9% after the Bex flexible linear reducer. The mean freedom rate from repair failure was 94+/-3% at five years after the Carpentier-Edwards prosthetic ring annuloplasty (p = 0.18 for comparison of the three freedom from failure curves).


CONCLUSIONS
All three techniques of tricuspid valve repair resulted in a low rate of failure, and in good patient survival at long-term follow up.
Carrier
Michel
M
Departments of Surgery, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada. michel.carrier@icm-mhi.org
Pellerin
Michel
M
Guertin
Marie-Claude
MC
Bouchard
Denis
D
Hébert
Yves
Y
Perrault
Louis P
LP
Cartier
Raymond
R
Basmadjian
Arsène
A
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D011792:Quebec; D016019:Survival Analysis; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography