Outcomes of ring versus suture annuloplasty for tricuspid valve repair in patients undergoing mitral valve surgery.
There is controversy regarding the comparative effectiveness of methods of tricuspid valve (TV) repair-prosthetic ring versus suture annuloplasty-in patients undergoing operation for primary mitral valve (MV) disease. In this study, we analyzed factors associated with patient survival and recurrent tricuspid regurgitation (TR) following TV repair and focused on results stratified by method of tricuspid valve repair.



We reviewed patients who underwent TV repair with suture (De Vega) or flexible ring annuloplasties at the time of MV surgery from 1995 to 2010. Patients with prior cardiac or concomitant aortic valve operations were excluded. Propensity matching was performed to account for potential differences in baseline characteristics between the groups. Primary outcomes were long-term mortality and postoperative TR grade.



In the overall study, there were 415 patients with median age 72 years (range, 63-78 years), from which 148 matched pairs were identified by propensity score analysis. In the overall cohort, patients in the ring annuloplasty group more often had preoperative transvenous pacemakers (P = .05), lower ejection fractions (P = .028), and more recent years of operation (P < .001). For patients who had De Vega suture annuloplasty, long-term mortality was not different from that of patients who had ring annuloplasty (hazard ratio, 0.93; 95% confidence interval, 0.67-1.30). Older age, preoperative diabetes, and preoperative right ventricular dysfunction were predictors for long-term mortality. Durability of the annuloplasty methods was similar with no significant difference in trend of recurrent TR grades over follow-up (P = .807). Etiology of mitral regurgitation was not associated with recurrent TR during follow-up (P = .857).



Late survival and TV durability following concomitant TV repair during MV surgery did not differ with respect to TV repair technique. In this series of patients with repaired tricuspid valves, etiology of MV disease did not influence postoperative changes in TR.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Sung Ho
SH
Shinn
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Victor
V
Dayan
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn. Electronic address: schaff@mayo.edu.
Hartzell V
HV
Schaff
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn.
Joseph A
JA
Dearani
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn.
Lyle D
LD
Joyce
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn.
Brian
B
Lahr
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Kevin L
KL
Greason
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
John M
JM
Stulak
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Richard C
RC
Daly
D000368:Aged; D016009:Chi-Square Distribution; D057186:Comparative Effectiveness Research; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*
tricuspid valve regurgitation; tricuspid valve repair