Surgical Treatment of Secondary Tricuspid Regurgitation: Insight Derived From Annulus Sizes and Tethering Distances.
BACKGROUND
The main goal of this study was to explore the feasibility of stratifying patients with secondary tricuspid regurgitation (TR) into different risk levels, and to compare the surgical outcomes of patients within different risk levels who underwent different tricuspid valve repair (TVP) approaches.


METHODS
One hundred and one patients with left-sided valvular disease underwent either left-sided valvular replacement or repair, and 79 patients underwent concomitant TVP. Depending upon their tricuspid annulus diameter and tethering distances, the patients were assessed using 4 risk levels. The different surgical approaches were used in patients within different risk levels.


RESULTS
Among the 101 patients, there were 32 patients within risk level I, 28 within risk level II, 20 within risk level III, 21 within risk level IV. In the first risk level, the patients with untreated tricuspid valves had no or mild TR after surgery. In the second and third risk levels, the patients treated with a modified De Vega procedure had mild TR at follow-up. In the fourth risk level, the patients treated with undersized annuloplasty rings exhibited an improved outcome.


CONCLUSIONS
The evaluation of both tricuspid annular diameter and tethering distance may help clinicians to stratify patients with secondary TR into different risk levels as a means of choosing an optimal TVP approach. The application of a modified De Vega procedure or an undersized annuloplasty ring in patients within appropriate risk level could improve the treatment for secondary TR.
Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Academy of Medical Sciences, and Peking Union Medical College, Beijing, P.R. China.
Hong
H
Meng
Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Academy of Medical Sciences, and Peking Union Medical College, Beijing, P.R. China. Electronic address: panshiwei816@sohu.com.
Shi-Wei
SW
Pan
Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Academy of Medical Sciences, and Peking Union Medical College, Beijing, P.R. China.
Sheng-Shou
SS
Hu
Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Academy of Medical Sciences, and Peking Union Medical College, Beijing, P.R. China.
Kun-Jing
KJ
Pang
Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Academy of Medical Sciences, and Peking Union Medical College, Beijing, P.R. China.
Jian-Feng
JF
Hou
Department of Echocardiography, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Academy of Medical Sciences, and Peking Union Medical College, Beijing, P.R. China.
Hao
H
Wang
D000328:Adult; D058385:Cardiac Valve Annuloplasty; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000033:anatomy & histology* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*