title: Mid-term results of leaflet augmentation in severe tricuspid functional tethering.
abstract: OBJECTIVE
  Functional tricuspid regurgitation (FTR) is usually managed surgically using various types of annuloplasty. FTR has been reported to recur in up to 45% of patients, with severe leaflet tethering being an important risk factor for recurrence. The aim of this study is to report the clinical and echocardiographic mid-term results after leaflet augmentation in patients with FTR due to severe leaflet tethering.
  
  
  METHODS
  From May 2008 to July 2014, 22 patients were found to have a severe FTR with a tethering height of at least 8 mm; all of them underwent leaflet augmentation: the anterior and part of the posterior leaflet were detached from the anterior annulus; a patch of fresh autologous pericardium was used to generously fill the gap between the anterior annulus and the detached leaflet. A 5/0 Pronova suture locked at every step was used to avoid any purse string effect. In 2 patients, the septal leaflet also needed to be augmented using a comparable technique. In all but one (annular calcification) patient, a semi-rigid ring annuloplasty was added. The mean age was 67.1 ± 13.7 years; it was a redo procedure in 12 cases (54.5%), 11 patients (50%) had right ventricle failure and 3 (23.1%) had renal failure.
  
  
  RESULTS
  The median follow-up was 2.1 ± 1.9 years. Thirty-day and 4-year survival averaged at 81.1 ± 8.5 and 71.6 ± 9.8%, respectively. At 4 years, 84 ± 10.6% of the survivors were in NYHA class I or II and only 2 patients had a TR of ≥2 with a global freedom from TR ≥2 of 85.7 ± 13.2%. There was no reintervention.
  
  
  CONCLUSIONS
  Tricuspid leaflet augmentation combined with annuloplasty is feasible and leads to excellent clinical and echocardiographical mid-term results even in the presence of severe leaflet tethering and right ventricular failure.
authors.affiliation: Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium matteo.pettinari@zol.be.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pettinari
authors.affiliation: Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bertrand
authors.affiliation: Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium.
authors.forename: Christiaan
authors.initials: C
authors.lastname: Van Kerrebroeck
authors.affiliation: Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Vandervoort
authors.affiliation: Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium.
authors.forename: Herbert
authors.initials: H
authors.lastname: Gutermann
authors.affiliation: Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Dion
mesh_terms: D000368:Aged; D001530:Belgium / Q000453:epidemiology; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*
keywords: Tricuspid valve regurgitation