title: Undersized tricuspid annuloplasty rings optimally treat functional tricuspid regurgitation.
abstract: BACKGROUND
  In contrast to mitral valve repair, residual and recurrent regurgitation after tricuspid valve (TV) repair for functional tricuspid regurgitation (TR) is common. We have systematically used undersized, rigid 3-dimensional annuloplasty rings to treat functional TR.
  
  
  METHODS
  From March 2006 to October 2009, 101 consecutive patients with moderate or greater functional TR underwent TV repair with an undersized rigid 3-dimensional annuloplasty ring. All patients had a predischarge echocardiography evaluation in a core echocardiography laboratory. Follow-up echocardiography was available for 96% of surviving patients. Mean follow-up was 17±9 months.
  
  
  RESULTS
  Twenty-nine percent of patients had undergone previous cardiac operations, 74% were in New York Heart Association functional class III or IV, and 48% had atrial fibrillation. Mitral valve operations were performed in 93 patients, aortic valve operations in 17, coronary artery bypass grafting in 21, and CryoMaze procedures in 40. Size 26 or 28 rigid tricuspid annuloplasty rings were used in 88% of patients, and no ring larger than a 28 has been used since November 2008. The operative mortality rate was 6% (n=6). Freedom from significant TR (TR>moderate) at hospital discharge, as assessed by the clinical core laboratory, was 97%. Only 3% of patients had TR greater than moderate during follow-up. No patient required TV reoperation. New postoperative permanent pacemakers were inserted in 3 patients.
  
  
  CONCLUSIONS
  Tricuspid valve repair with an undersized (size 26 or 28) rigid 3-dimensional annuloplasty ring is the method of choice for reliable and durable treatment of functional TR.
authors: Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
authors: Mehrdad
authors: M
authors: Ghoreishi
authors: Jamie M
authors: JM
authors: Brown
authors: Craig E
authors: CE
authors: Stauffer
authors: Cindi A
authors: CA
authors: Young
authors: Mary J
authors: MJ
authors: Byron
authors: Bartley P
authors: BP
authors: Griffith
authors: James S
authors: JS
authors: Gammie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011474:Prosthesis Design; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*