Comparative Study of Three Techniques of Repair for Severe Functional Tricuspid Valve Regurgitation

Abstract

Ahmed M.A Shafeek, Khalid Hassan AbdEl Bary, Mohamed Essa, and Ehab Sobhy

Background: The optimal technique for repair of functional tricuspid valve regurgitation (FTR) remains uncertain. Various modalities of annuloplastyhave been used to repair such pathology, including rigid or flexible rings (complete or incomplete), sutures, and bands.
Aim of work: The goal of this study was to compare the outcome of tricuspid valve (TV) repair by pericardial band, Dacron band and Carpentier ring in patients with left sided valve surgery.
Patients & Methods: This study was conducted from October 2016 to December 2019 and included 123 patients with functionally severe tricuspid regurgitation secondary to left-sided valve diseases (isolated mitral valve disease or combined mitral and aortic valve disease).Those patients were operated at Zagazig University Hospitals and Nasser Institute. We randomized patients into three groups according to the method used for management of tricuspid regurgitation. There were 41 patients in each group. Repair of TV was performed using Carpentier-Edwards Physio Tricuspid annuloplasty ring in group (A), Dacron band in group (B), and pericardial band in group (C). As, there was one mortality in each group, only 40 patients were enrolled in statistical analysis for each group.
Results: There was no significant difference between the three groups regarding the preoperative findings including age, sex, BMI, NYHA functional class and preoperative echocardiography findings. Duration of ward stay was longer in the pericardial group. Postoperatively, there was significant reduction in the mean pulmonary artery systolic pressure (PASP) and right ventricular dimension in the three groups, and notably evident in group (A).
Conclusion: Using semi-rigid (Carpentier-Edwards Physio Tricuspid annuloplasty ring) or flexible ring (Dacron band) or pericardial strip are good options in the repair of functional tricuspid valve regurgitation. However, Carpentier ring placement is s consistent with improved RV remodeling and is likely to improve the right ventricular efficiency and a favorable result.