Carpentier’s flexible ring versus De Vega’s annuloplasty

Rivera, Ramiro; Duran, Érika Christiane Marocco; Ajuria, M

doi:10.1016/s0022-5223(19)38814-2

Cited by 130 publications

(52 citation statements)

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“…The rate of residual or recurrent moderate‐to‐severe or severe TR after tricuspid annuloplasty is around 11–15% one to three months after surgery and increases to 17–24% after 5 years 5,6 . Several predictors of tricuspid repair failure have been identified including the severity of preoperative TR, 5,6,16 pulmonary hypertension, 16 presence of pacemakers, 5 left ventricular (LV) dysfunction, 5 increased LV remodeling, 6 severe tethering of the tricuspid leaflets, and the use of suture rather than ring annuloplasty 5,6,17‐19 . Indeed most of the published studies, both randomized and observational, have demonstrated that ring annuloplasty repairs are more durable than suture annuloplasty 5,6,17‐19 .…”

Section: Discussionmentioning

confidence: 99%

“…Several predictors of tricuspid repair failure have been identified including the severity of preoperative TR, 5,6,16 pulmonary hypertension, 16 presence of pacemakers, 5 left ventricular (LV) dysfunction, 5 increased LV remodeling, 6 severe tethering of the tricuspid leaflets, and the use of suture rather than ring annuloplasty 5,6,17‐19 . Indeed most of the published studies, both randomized and observational, have demonstrated that ring annuloplasty repairs are more durable than suture annuloplasty 5,6,17‐19 . Among the different types of prosthetic rings, the semirigid or rigid ones (either standard or 3‐dimensional) have been associated with the least increase across time of recurrent tricuspid insufficiency, 5,6 providing better long‐term survival and event‐free survival up to 15 years after surgery compared to suture annuloplasty 20 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mid-Term Results of Tricuspid Annuloplasty with a Three-Dimensional Remodelling Ring

Bonis

Lapenna

Taramasso

et al. 2012

Journal of Cardiac Surgery

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Objective: To assess the results of tricuspid annuloplasty performed with the Edwards MC3 remodeling ring. Methods: From 2005 to 2007, 140 patients with tricuspid regurgitation (TR) secondary to left‐sided valve disease (mean age 63.8 ± 11.6, permanent pacemaker in 7.8%, LVEF 56.4 ± 10.1%, LVEDD 54.1 ± 8 mm, SPAP 52.5 ± 14.4 mmHg) underwent tricuspid annuloplasty using the MC3 ring. Dilatation of the tricuspid annulus was present in all patients. Other concomitant mechanisms of TR (moderate leaflet prolapse, pacemaker wires, leaflets’ retraction) were documented in 21 cases (15%). All patients underwent concomitant left‐sided valve surgery. Ring size was between 28 and 32 in 84.3% of patients. Results: Hospital mortality was 3.5% and actuarial survival at 3 years 94.8 ± 2.1%. Mean follow‐up of the 135 hospital survivors was 22 ± 9.5 months (median 23 months). Echocardiography at hospital discharge documented no or mild TR in 119 patients (87%), moderate TR (2+/4+) in 15 (11%) and moderate‐to‐severe (3+/4+) in 1 patient (0.7%). At echocardiographic follow‐up moderate TR was present in 14 patients (10.3%) and moderate‐to‐severe TR in 2 (1.4%). At 3 years freedom from TR ≥ 2+ was 88.1 ± 2.78% and freedom from TR ≥ 3+ was 94.3 ± 4.89. Predictors of TR ≥ 2+ at hospital discharge and at follow‐up were preoperative LVEF (OR:0.8; p = 0.001 at discharge; HR:0.9; p = 0.003 at follow‐up) and the presence of other mechanisms of TR besides annular dilatation (OR:10.8; p = 0.007 at discharge; HR:6.1; p = 0.003 at follow‐up).Conclusion: Tricuspid annuloplasty with the MC3 ring provides satisfactory early results which remain stable at mid‐term follow‐up. The presence of other mechanisms besides annular dilatation leads to residual valve insufficiency after ring annuloplasty alone. (J Card Surg 2012;27:288‐294)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mid-Term Results of Tricuspid Annuloplasty with a Three-Dimensional Remodelling Ring

Bonis

Lapenna

Taramasso

et al. 2012

Journal of Cardiac Surgery

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“…The DeVega suture repair is the most commonly used technique of TV repair. However, high recurrence rates have been reported with DeVega repair, particularly in patients with severe tricuspid annular dilation and/or pulmonary hypertension [12]. To overcome this issue, the search focused on the use of more anatomically relevant techniques for the management of FTR.…”

Section: Discussionmentioning

confidence: 99%

Outcome of MC3 ring annuloplasty for moderate and severe functional tricuspid regurgitation associated with rheumatic mitral valve disease

2019

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Background: To evaluate early and midterm outcomes of tricuspid ring annuloplasty using three-dimensional (3D) MC3 ring for treatment of functional tricuspid regurgitation (FTR) during mitral valve replacement for rheumatic valve disease. Results: This prospective study included 105 patients who underwent repair for ≥ moderate tricuspid regurgitation (TR) during mitral valve replacement for rheumatic valve disease. Between January 2016 and December 2018, a group of 23 patients who underwent ring annuloplasty with Edward MC3 rings was compared to another group of 82 patients who underwent standard suture (DeVega) repair. The primary outcome was residual TR (≥ moderate TR). During an average follow-up period of 18.84 ± 9.90 months (range 3-33 months), the preoperative grade of TR improved significantly in both groups. The postoperative mean of TR in the MC3 group was significantly lower than that in the DeVega group (0.17 ± 0.49 versus 0.77 ± 0.93, P = 0.004). The rate of TR recurrence (≥ 2+ TR) was significantly higher after MC3 ring annuloplasty (4.3% versus 23.1%, P = 0.03). Freedom from mild TR was 30.5% in the DeVega group and 61% in the ring annuloplasty group (P = 0.007). Freedom from residual TR was 76.8% in the DeVega group and 95.7% in the ring annuloplasty group (P = 0.04). Conclusions: The use of MC3 rings is a safe and effective alternative to DeVega repair for the management of FTR. However, further evaluation of long-term durability is recommended.

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“…Hashimoto et al11 reported that insufficient reduction of the orifice or insecure annular plication is likely because suturing in the septal annulus is usually avoided. More importantly, Rivera et al 12 reported that De Vega's method produces semicircular deformation of the orifice and causes infolding of the leaflets and impairment of long-term function. In addition, the final procedure of adjustment is highly variable and depends on the experience of the surgeon.…”

Section: Resultsmentioning

confidence: 99%

Modification of De Vega's Tricuspid Annuloplasty for Experimental Tricuspid Regurgitation

Otaki¹,

Lust²

1994

J Cardiac Surgery

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We propose a new experimental model of tricuspid annular dilatation and provide some modifications to De Vega's tricuspid annuloplasty to treat this condition. Tricuspid annular dilatation was done by creating ten 1.5-mm incisions around the circumference of the tricuspid annulus. The annulus became significantly dilated from 7.6 cm to 9.4 cm (p < 0.01). After dilatation, 2-0 polypropylene stitches were placed circumferentially around the tricuspid annulus and the suture ends were brought outside the heart through the right atrial wall. After cardiac resuscitation, the following hemodynamic variables were measured as preload was increased incrementally: mean right atrial pressure, v wave of atrial pressure, right ventricular end-diastolic pressure, and cardiac output. Measurements were obtained and preload-output curves were constructed for three time periods: before annular dilatation (Control); after dilatation, but before external adjustment (Before); and after external modification of the annulus (After). Following cardiac resuscitation, right atrial and ventricular pressures were significantly higher after annular dilatation, compared to control values. The preload-output curve was shifted to the right, and cardiac output could not be increased above 0.9 L/min. Once the extracardiac adjustment was accomplished, these pressures were returned to control values, and the preload-output relationship was returned to normal curve.

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Carpentier’s flexible ring versus De Vega’s annuloplasty

Cited by 130 publications

References 4 publications

Mid-Term Results of Tricuspid Annuloplasty with a Three-Dimensional Remodelling Ring

Mid-Term Results of Tricuspid Annuloplasty with a Three-Dimensional Remodelling Ring

Outcome of MC3 ring annuloplasty for moderate and severe functional tricuspid regurgitation associated with rheumatic mitral valve disease

Modification of De Vega's Tricuspid Annuloplasty for Experimental Tricuspid Regurgitation

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