title: Increased risk of dehiscence after tricuspid valve repair with rigid annuloplasty rings.
abstract: OBJECTIVE
  Surgical management of tricuspid valve regurgitation mainly consists of tricuspid valve annuloplasty, usually performed with implantation of a rigid ring or a flexible band.
  
  
  METHODS
  We performed a retrospective analysis on 820 patients who underwent tricuspid valve repair between March 2002 and July 2009 with either a flexible Cosgrove-Edwards band (n = 415; Edwards Lifesciences LLC, Irvine, Calif) or a rigid Carpentier-Edwards Classic annuloplasty ring (n = 405; Edwards Lifesciences). Mean patient age was 69.2 ± 9.5 years, 54.1% were female, and average logistic EuroSCORE was 13.3% ± 12.5%. Concomitant procedures were performed in 94.6% of patients (mitral valve surgery, 80.6%; aortic valve surgery, 28.2%; coronary artery bypass grafting, 24.5%; atrial fibrillation ablation, 44.5%). One fifth of the operations were reoperative procedures. Follow-up was 94% complete, with mean duration of 21.0 ± 19.0 months.
  
  
  RESULTS
  Thirty-day mortality was 10.1% (Cosgrove-Edwards, 11.9%; Carpentier-Edwards, 8.4%), and 5-year survival was 62.4% (Carpentier-Edwards, 64.7%; Cosgrove-Edwards, 60.3%). Postoperative echocardiography showed significant improvement in tricuspid valve function, with reduction in tricuspid regurgitation grade from 2.3 ± 0.7 to 0.7 ± 0.7, and no differences between groups. Use of a Carpentier-Edwards ring, however, was associated with significantly higher risk of dehiscence (Carpentier-Edwards, 8.7%; Cosgrove-Edwards, 0.9%; P < .001), almost exclusively at the septal leaflet portion of the annulus. Multivariate analysis identified annuloplasty type as independently predicting ring dehiscence (odds ratio, 10.7; 95% confidence interval, 3.2-36.5; P < .001). Patients with annuloplasty dehiscence had more residual tricuspid regurgitation on predischarge echocardiography than did patients without dehiscence (1.4 ± 0.63 vs 0.7 ± 0.6; P < .001). Ten patients underwent reoperation for recurrent tricuspid regurgitation, 4 with ring dehiscence. Five-year freedom from reoperation was 95.3% (Cosgrove-Edwards, 97.7%; Carpentier-Edwards, 92.3%).
  
  
  CONCLUSIONS
  Although both rigid and flexible systems provide acceptable early tricuspid valve repair results, use of a rigid ring increases risk of subsequent ring dehiscence.
authors.affiliation: Department of Cardiac Surgery, University of Leipzig Heart Center, Leipzig, Germany. bettina.pfannmueller@med.uni-leipzig.de
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfannmüller
authors.forename: Torsten
authors.initials: T
authors.lastname: Doenst
authors.forename: Katja
authors.initials: K
authors.lastname: Eberhardt
authors.forename: Jörg
authors.initials: J
authors.lastname: Seeburger
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014463:Ultrasonography