title: Identical tricuspid ring sizing in simultaneous functional tricuspid and mitral valve repair: A simple and effective strategy.
abstract: OBJECTIVE
  Mitral valve repair for functional mitral regurgitation is common. Concomitant tricuspid valve repair for associated functional tricuspid regurgitation has gained favor. Controversy exists regarding annuloplasty sizing for tricuspid valve repair.
  
  
  METHODS
  Patients with heart failure having functional mitral regurgitation at the University of Michigan and undergoing mitral valve repair and tricuspid valve repair using identical sized annuloplasty rings between April 2007 and January 2012 were identified. Demographic and clinical records were retrospectively reviewed. Institutional review board approval was obtained for this study.
  
  
  RESULTS
  Fifty-three patients met inclusion criteria. Mean age was 65 ± 1.7 years. Preoperative New York Heart Association class was III or IV in 81% (43) and mean left ventricular ejection fraction was 33% ± 2.2%. All patients had moderate or greater mitral regurgitation preoperatively and moderate or severe tricuspid regurgitation or a preoperative tricuspid annulus diameter greater than 40 mm. There was no 30-day mortality. Mean immediate postoperative tricuspid valve gradient was 1.75 ± 0.12 mm Hg and was 2.3 ± 0.19 mm Hg at 4 weeks. Four weeks postoperatively 88% (42/48) of patients had tricuspid regurgitation considered to be mild or less. There was no significant decline in right ventricular function by echocardiography over this time period.
  
  
  CONCLUSIONS
  Functional tricuspid regurgitation can be repaired using an undersized rigid annuloplasty ring. Our data suggest that an identical sizing strategy can be used for tricuspid valve repair, as was used for mitral valve repair, without development of tricuspid stenosis or negative effect on right ventricular function. This method seems to prevent recurrence of significant tricuspid regurgitation. The technique we describe provides effective and reproducible results.
authors.affiliation: University of Michigan, Ann Arbor, Mich.
authors.forename: Lynn C
authors.initials: LC
authors.lastname: Huffman
authors.affiliation: University of Michigan, Ann Arbor, Mich. Electronic address: jensnels@umich.edu.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Nelson
authors.affiliation: University of Michigan, Ann Arbor, Mich.
authors.forename: April N
authors.initials: AN
authors.lastname: Lehman
authors.affiliation: University of Michigan, Ann Arbor, Mich.
authors.forename: Marguerite C
authors.initials: MC
authors.lastname: Krajacic
authors.affiliation: University of Michigan, Ann Arbor, Mich.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Bolling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: 22; 35.3.3; 35.3.7; 35.4.1; CI; MV; RV; TR; TS; TV; confidence interval; mitral valve; right ventricular; tricuspid regurgitation; tricuspid stenosis; tricuspid valve