title: Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes.
abstract: BACKGROUND
  The purpose of this study was to compare the long-term results of tricuspid valve (TV) repair with or without an annuloplasty ring.
  
  
  RESULTS
  702 patients underwent TV repair at our institution (1978 to 2003), of which 493 had, predominantly, a De Vega procedure (no ring) and 209 had an annuloplasty ring (ring). TV pathology was functional (secondary) in 74% of patients. Concomitant procedures consisted of mitral valve surgery in 80% of patients, aortic valve surgery in 33%, and coronary bypass in 14%. Clinical and echocardiographic follow-up data were obtained. Follow-up was 99% complete and was 5.9+/-4.9 (mean+/-SD) years long. Ring patients were younger (55+/-14 versus 59+/-14 years; P=0.001) and less likely to have coronary artery disease (10% versus 17%; P=0.02), more likely to be female (75% versus 65%; P=0.01) and having had previous cardiac surgery (56% versus 42%; P=0.001). Operative times were similar between the 2 groups. Long-term survival, event-free survival and freedom from recurrent TR were significantly better in the ring group, and there was a trend toward fewer TV reoperations. Multivariable analysis demonstrated that the use of an annuloplasty ring was an independent predictor of long-term survival (hazard ratio [HR], 0.7; 95% confidence interval [CI], 0.5 to 1.0; P=0.03) and event-free survival (HR, 0.8; CI, 0.6 to 1.0; P=0.04).
  
  
  CONCLUSIONS
  Placement of an annuloplasty ring in patients undergoing tricuspid valve repair is associated with improved survival and event-free survival.
authors.affiliation: Division of Cardiovascular Surgery, Toronto General Hospital, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gilbert H L
authors.initials: GH
authors.lastname: Tang
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
authors.forename: Steve K
authors.initials: SK
authors.lastname: Singh
authors.forename: Manjula D
authors.initials: MD
authors.lastname: Maganti
authors.forename: Susan
authors.initials: S
authors.lastname: Armstrong
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D019736:Prostheses and Implants; D012737:Sex Factors; D016019:Survival Analysis; D013536:Suture Techniques; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology / Q000601:surgery; D014463:Ultrasonography