title: Adjustable segmental tricuspid annuloplasty: technical advantages and midterm results.
abstract: BACKGROUND
  Adjustable segmental tricuspid annuloplasty is a new recently published procedure. The purpose of this prospective study was to present the technical advantages of this new tricuspid annuloplasty and analyze its early and midterm results.
  
  
  METHODS
  Between January 2004 and December 2006, 17 patients who had moderate or severe pure functional tricuspid regurgitation (TR) underwent adjustable segmental tricuspid annuloplasty. The mean age of the patients was 64.3 +/- 10.4 years and the majority were female (94%). All patients had recent preoperative transthoracic echocardiography (TTE). Three postoperative TTE were performed: (I) before the hospital discharge; (II) between 3 and 6 months after surgery; and (III) at a mean 30.4 +/- 13.8 months of follow-up. We studied the tricuspid valve, right ventricle, and left ventricle.
  
  
  RESULTS
  No hospital mortality was reported. Progressive overall clinical improvement was observed. Serial postoperative TTE revealed the following: (1) 13 patients with mild or less than mild TR, 1 patient with residual moderate TR, 1 patient with early moderate TR related to poor left ventricular function, and 1 patient with late severe TR due to a transvenous pacemaker lead; (2) the indexed tricuspid annulus diameter normalized in all patients; (3) pulmonary hypertension gradually regressed; and (4) right ventricular end-diastolic diameter and inferior vena cava diameter gradually decreased throughout the study.
  
  
  CONCLUSIONS
  Adjustable segmental tricuspid annuloplasty is an improved and efficient procedure for functional TR because it is more selective, more adjustable and more resistant. It may be adversely influenced by poor left ventricular function and by the presence of a pacemaker lead.
authors.affiliation: Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Universidad Autónoma, Madrid, Spain. anas_sarraj@hotmail.com
authors.forename: Anas
authors.initials: A
authors.lastname: Sarraj
authors.forename: José-Manuel
authors.initials: JM
authors.lastname: Nuche
authors.forename: Lourdes
authors.initials: L
authors.lastname: Domínguez
authors.forename: Luís-Miguel
authors.initials: LM
authors.lastname: García
authors.forename: Guillermo
authors.initials: G
authors.lastname: Reyes
authors.forename: Juan
authors.initials: J
authors.lastname: Bustamante
authors.forename: Pablo
authors.initials: P
authors.lastname: Alvarez
authors.forename: Juan
authors.initials: J
authors.lastname: Duarte