title: Flexible band versus rigid ring annuloplasty for functional tricuspid regurgitation: two different patterns of right heart reverse remodelling.
abstract: Annuloplasty bands and rings are widely used to treat functional tricuspid regurgitation (TR). However, the question as to which is the ideal annuloplasty device remains open. Early and late outcomes of tricuspid valve annuloplasty with flexible band (B-TVA) or rigid ring (R-TVA) are compared in the present study.
  
  
  
  Between 1999 and 2014, 462 consecutive patients (mean age, 69.2 ± 9.5 years) with grade ≥1+ functional TR (graded from 0 to 3+) underwent either B-TVA (n = 345; mean EuroSCORE II 9.2 ± 10.8%) or R-TVA (n = 117; mean EuroSCORE II 12 ± 13.4%) in addition to other cardiac procedures at the authors' institution.
  
  
  
  One-to-one propensity score-matched analysis resulted in 98 pairs with similar baseline characteristics and operative risk. Hospital mortality was 7.5% after B-TVA and 12% after R-TVA (P = 0.14). R-TVA was associated with higher rates of low cardiac output (10.1 vs 17.9%, P = 0.025) and transient complete atrioventricular block (10.3 vs 17.2%, P = 0.046). Among the matched pairs, there were no significant differences in hospital mortality (5.1 vs 9.2%, P = 0.27) and perioperative complications. Both in overall series and matched pairs, between B-TVA and R-TVA patients, there were no significant differences in freedom from all-cause death (P = 0.29 and 0.91), cardiac and cerebrovascular deaths (P = 0.63 and 0.87) and grade ≥2+ TR (P = 0.68 and 0.77). Right atrial and tricuspid valve reverse remodelling combined with right ventricular reverse remodelling occurred after R-TVA but not after B-TVA.
  
  
  
  B-TVA and R-TVA are equally effective in the treatment of functional TR. However, R-TVA causes over time a more complete right heart reverse remodelling.
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy gius.gatti@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Dell'Angela
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Morosin
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Maschietto
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Benussi
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Forti
authors.affiliation: Department of Cardiology, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Nicolosi
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Aniello
authors.initials: A
authors.lastname: Pappalardo
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000295:instrumentation*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D020257:Ventricular Remodeling
keywords: Echocardiography; Prosthesis; Reverse remodelling; Surgery; Valve regurgitation