Outcomes of De Vega versus Biodegradable Ring Annuloplasty in the Surgical Treatment of Tricuspid Regurgitation (Mid-term Results)

Başel, Halil; Ünal, Aydın; Kutlu, Hakan; Dostbil, Ayşenur; Karadağ, Melike; Odabaşı, Dolunay; Aydın, Cemalettin

doi:10.1532/hsf98.20091170

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…Our result is consistent with Basel and colleagues [12] who studied 129 patients with severe secondary tricuspid regurgitation and found that the number of patients who developed residual TR was significantly lower in the ring group. Ren and colleagues [13] found that ring annuloplasty was associated with improved survival, decreased TR recurrence and higher quality of life in rheumatic heart disease patients undergoing tricuspid valve repair combined with mitral and/or aortic valve replacement.…”

Section: Discussionsupporting

confidence: 93%

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

Hamdy

Mostafa

Elminshawy

2019

Egypt. Cardiothoracic. Surg.

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Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

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Section: Discussionsupporting

confidence: 93%

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

Hamdy

Mostafa

Elminshawy

2019

Egypt. Cardiothoracic. Surg.

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“…It is well known that residual TR after surgical repair can lead to biventricular failure, death or reoperation [8], and therefore, the choice of repair is dictated predominantly by the recurrence rate of the procedure. The reported recurrence rates with De Vega's annuloplasty appear to be higher compared with ring repair [2,[4][5][6][9][10][11][12]. However, the only available randomized control trial on this issue is almost two decades old, when diagnosis of TR and its severity, both preoperatively and after, was on clinical grounds [13].…”

Section: Resultsmentioning

confidence: 99%

“…Basel et al [12] performed a study of 129 patients undergoing annuloplasty for TR. Of this group, 67 had undergone ring annuloplasty and the remaining 62 patients had undergone De Vega's annuloplasty.…”

Section: Resultsmentioning

confidence: 99%

Is a tricuspid annuloplasty ring significantly better than a De Vega's annuloplasty stitch when repairing severe tricuspid regurgitation?

Khorsandi

Banerjee

Singh

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether tricuspid valve (TV) repair with an annuloplasty ring leads to an improved outcome over a conventional suture annuloplasty for patients with severe tricuspid incompetence. Altogether, 306 papers were found using the reported search, of which 14 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We found seven studies supporting the use of ring annuloplasty over De Vega's suture annuloplasty. Five studies found no significant difference in outcome between the two techniques. We found only two studies supporting the use of De Vega's suture annuloplasty over ring annuloplasty. Therefore, most of the tabulated studies show good evidence in support of ring annuloplasty compared with De Vega's suture repair for treatment of moderate to severe TV regurgitation. One cohort study identified a 20.4% postoperative failure rate for tricuspid regurgitation (TR) repair and concluded non-application of ring as a predictor for reoperation. One cohort study with a mean follow-up of 17 months reported success rates as high as 97% with ring annuloplasty for TV regurgitation. One large cohort study of 2277 patients with TR who had undergone repair reported a sustained reduction in TR and the rate of recurrence in a 5-year echocardiographic follow-up. One cohort study of 129 patients concluded that ring annuloplasty has the lowest rate of recurrence compared with De Vega's suture repair. An old randomized controlled trial (RCT) on the subject also reported a similar result to the mentioned studies. In contrast, we reviewed one recent study and four older studies and found no significant difference between the two techniques. We reviewed one study that reported De Vega's suture repair as a superior technique to ring annuloplasty. We conclude that there is good evidence supporting ring annuloplasty over conventional De Vega's suture annuloplasty.

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“…Multiple studies support the better outcome of using rigid ring annuloplasty over suture repair for treating FTR in concern with the durability and freedom from residual regurgitation. These studies refer the superiority of rigid ring annloplasty to the threedimensional configuration achieved by such rings which matches the normal tricuspid annulus and, at the same time, to the rigid support of the annulus [2][3][4][5][6]. On the other hand, other studies support the use of flexible prosthetic bands like Dacron or polytetrafluroethilin (PTFE), especially over suture techniques, due to their easy applicability and availability with good postoperative results [7,8].…”

Section: Backgroundsmentioning

confidence: 99%

Tricuspid three-dimensional ring versus fashioned flexible band annuloplasty in management of functional tricuspid valve regurge: comparative long term study

et al. 2020

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Background: Functional tricuspid valve regurgitation due to left sided valve lesions remains a common finding. Nowadays, different types of three-dimensional rings and flexible bands are considered to be the gold standard techniques for repair of such functional regurgitation. Our study aimed for long-term comparison of the durability and effectiveness of those techniques. Results: The data of 170 adult patients with moderate or more functional tricuspid regurgitation secondary to mitral stenosis or regurgitation receiving tricuspid valve repair using either rigid 3D rings (contour 3D or MC3 ring) or prosthetic fashioned bands (Dacron or PTFE) and mitral valve surgery between March 2013 and September 2018 were collected and analysed. Patients were classified in two matched groups: ring group (group A) consisting of 90 cases and band group (group B) consisting of 80 cases. follow-up period ranged from 55.2 to 78 months (mean 67.2 ± 10.8), during this period New York heart association for dyspnea functional class evaluation and full echocardiographic assessment were done and was scheduled as following: before hospital discharge, after 6 months of surgery and finally, every 2 years. In-hospital mortality was 1(1.1%) and 2 (2.5%) with p value 0.49 after ring or band annuloplasty, respectively. No significant differences in both groups regarding hospital mortality and morbidities. There was statistically significant decrease in NYHA class, degree of TR, and PASP within the 2 groups postoperatively with p value of 0.03, 0.04, and 0.033, respectively, with no statistically significant difference between both groups (p value > 0.05). There was statistically significant difference in the freedom from recurrent TR and need for reoperation during the follow-up period between both groups with lower recurrence and reoperation rates in group A, (p value 0.03 and 0.001, respectively). Conclusion: Tricuspid valve repair with different annuloplasty rigid three dimensional rings or fashioned flexible bands for functional tricuspid regurgitation offers good long-term outcome. Yet, the rigid rings maintain their benefits on the rate of recurrent TR and the need for reoperation.

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Outcomes of De Vega versus Biodegradable Ring Annuloplasty in the Surgical Treatment of Tricuspid Regurgitation (Mid-term Results)

Abstract: The biodegradable ring annuloplasty technique may be used easily and safely in moderate and severe cases of tricuspid regurgitation; however, larger clinical series are necessary to confirm our promising results.

Cited by 9 publications

References 9 publications

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

Is a tricuspid annuloplasty ring significantly better than a De Vega's annuloplasty stitch when repairing severe tricuspid regurgitation?

Tricuspid three-dimensional ring versus fashioned flexible band annuloplasty in management of functional tricuspid valve regurge: comparative long term study

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