Comparison of outcomes of tricuspid annuloplasty with 3D-rigid versus flexible prosthetic ring for functional tricuspid regurgitation secondary to rheumatic mitral valve disease

Abstract

Background: Annuloplasty bands and rings are widely used for repairing functional tricuspid regurgitation (FTR). However, the question regarding which is the ideal annuloplasty device remains unclear. The aim of this study was to compare the efficacy and mid-term durability of tricuspid ring annuloplasty for FTR secondary to rheumatic mitral valve disease using flexible Cosgrove-Edwards band and the rigid Edwards Results: The grade of TR was significantly improved compared to preoperative values in two groups.There was no significant difference regarding postoperative TR grade between the two groups at 1 week and 2-3 months but there was statistical significant difference at postoperative 6-12 months, and 2-3 years.During the follow up period, 25 of 46 patients (54.3%) in flexible group and 22 of 60 patients (30.3%) in rigid group developed recurrent TR. Freedom from recurrent TR in flexible group is significant lower than rigid group in each postoperative follow up period.Conclusions: These findings suggest that 3D rigid ring annuloplasty might be more effective for tricuspid ring annuloplasty in FTR in mid-term postoperative periods when compared to flexible band.

Flexible band versus rigid ring annuloplasty for tricuspid regurgitation: a systematic review and meta-analysis

“…In fact there have been reports that rings can have lower rates of recurrent TR than flexible bands, although both adequately control TR (9,24). Previous studies have reported that the grade of TR after rigid ring is relatively stable across time whilst slowly increasing after flexible band (8,9,20). Our results are consistent with these findings, as significant differences in freedom from TR were only seen after long term follow-up.…”

“…We identified six studies (8,9,14,(18)(19)(20) that met our inclusion criteria, of which one study was excluded from analysis due to overlapping population (9). Finally, we included a total of five studies with 3,141 patients of which 1,893 had a flexible band and 1,248 had a rigid ring.…”

“…There were differences in the inclusion criteria based on degree of TR. One study included patients with at least mild TR (18), two of the studies included patients with at least moderate TR (19,20), one study included patients with severe TR or moderate TR requiring other cardiac surgery (14) and one study did not specify the degree of TR but all the patients had concomitant aortic or mitral valve surgery (8). Among the five studies, only three provided information for analysis of long-term follow-up (8,14,18).…”

“…The flexible bands are designed to allow natural physiological motion of the tricuspid annulus throughout the cardiac cycle but this may hinder optimal positioning and maintenance of the saddle annulus (20). The flexible band is implanted from the anteroseptal to posteroseptal commissure, whereas the rigid ring is implanted from the anteroseptal commissure to the middle of the septal leaflet.…”

De Vega annuloplasty versus ring annuloplasty for repair of functional tricuspid regurgitation

“…[6][7][8] Functional TR secondary to annular dilation can be repaired with annuloplasty ring or without (De Vega). 9,10 Comparing the long-term outcome of TV repair with annuloplasty ring or DE VEGA annuloplasty was the aim of our study.…”