title: Mid-term results of tricuspid annuloplasty with a three-dimensional remodelling ring.
abstract: OBJECTIVE
  To assess the results of tricuspid annuloplasty performed with the Edwards MC3 remodeling ring.
  
  
  METHODS
  From 2005 to 2007, 140 patients with tricuspid regurgitation (TR) secondary to left-sided valve disease (mean age 63.8 ± 11.6, permanent pacemaker in 7.8%, LVEF 56.4 ± 10.1%, LVEDD 54.1 ± 8 mm, SPAP 52.5 ± 14.4 mmHg) underwent tricuspid annuloplasty using the MC3 ring. Dilatation of the tricuspid annulus was present in all patients. Other concomitant mechanisms of TR (moderate leaflet prolapse, pacemaker wires, leaflets' retraction) were documented in 21 cases (15%). All patients underwent concomitant left-sided valve surgery. Ring size was between 28 and 32 in 84.3% of patients.
  
  
  RESULTS
  Hospital mortality was 3.5% and actuarial survival at 3 years 94.8 ± 2.1%. Mean follow-up of the 135 hospital survivors was 22 ± 9.5 months (median 23 months). Echocardiography at hospital discharge documented no or mild TR in 119 patients (87%), moderate TR (2+/4+) in 15 (11%) and moderate-to-severe (3+/4+) in 1 patient (0.7%). At echocardiographic follow-up moderate TR was present in 14 patients (10.3%) and moderate-to-severe TR in 2 (1.4%). At 3 years freedom from TR ≥ 2+ was 88.1 ± 2.78% and freedom from TR ≥ 3+ was 94.3 ± 4.89. Predictors of TR ≥ 2+ at hospital discharge and at follow-up were preoperative LVEF (OR:0.8; p = 0.001 at discharge; HR:0.9; p = 0.003 at follow-up) and the presence of other mechanisms of TR besides annular dilatation (OR:10.8; p = 0.007 at discharge; HR:6.1; p = 0.003 at follow-up).
  
  
  CONCLUSIONS
  Tricuspid annuloplasty with the MC3 ring provides satisfactory early results which remain stable at mid-term follow-up. The presence of other mechanisms besides annular dilatation leads to residual valve insufficiency after ring annuloplasty alone.
authors.affiliation: Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. michele.debonis@hsr.it
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lapenna
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.forename: Mario
authors.initials: M
authors.lastname: Manca
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Calabrese
authors.forename: Nicola
authors.initials: N
authors.lastname: Buzzatti
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rossodivita
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.forename: Enrica
authors.initials: E
authors.lastname: Dorigo
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058385:Cardiac Valve Annuloplasty / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014463:Ultrasonography