Tricuspid Valve Repair: Devega’s Tricuspid Annuloplasty in Moderate Secondary Tricuspid Regurgitation

Abstract

Background Moderate secondary tricuspid incompetence has variable natural history if left unattended during mitral valve surgery. Recent data suggest progression of the secondary tricuspid incompetence over time. Secondary moderate tricuspid regurgitation in rheumatic mitral valve disease may regress after mitral valve surgery without direct intervention. Objectives: The present retrospective comparative hospital based tudy was done to assess early result of DeVega tricuspid valve annuloplasty amongst those with moderate tricuspid regurgitation due to rheumatic mitral valve disease. Methods: Group I (mitral valve replacement with tricuspid repair) and Group II (mitral valve replacement only) were compared regarding functional class, heart rate, rhythm, cardiac dimensions, function and valve pathology. The two groups were followed up at three months post-operatively and evaluated for their functional class and echocardiography variables. The data was analyzed with SPSS 16.0 Results: There were 43 patients who underwent mitral valve replacement with moderate tricuspid regurgitation. Twenty three underwent mitral valve replacement with tricuspid repair group (Group 1). Most of the patients were women (28/43). The mean age was 31.4 + 14.8 and 25.13 + 9.4 years. Group I had 21(91.3%) and Group II had 17 (85%) in NYHA class III & IV. The pre-operative echocardiographic cardiac left ventricular and left atrial dimensions, left ventricular function and valve lesions were statistically similar for both groups, except PASP was higher amongst tricuspid repair (Group 1: 38.60 + 12.75mHg, Group 2: 61.52 + 19.76mmHg; p= <0.05). At three month’s review after surgery, four patients were in NYHA II amongst those without tricuspid repair (Group II), whilst the rest were in NYHA I. Left ventricular dimensions, Left Ventricular function and valve prosthetic valve function were similar between groups. Eleven (47.8%) patients in Group I and only five (25%) of Group II had trace or less TR at the follow-up (p < 0.05). There were 7 (16.2%) patients who had persistent moderate TR. Higher PASP and larger LV dimensions at three months were predictive of persistent moderate TR. Conclusion Mitral valve replacement does decrease the severity of tricuspid regurgitation amongst those with secondary moderate tricuspid regurgitation by at least one grade, but DeVega’s annuloplasty confers a better repair result. http://dx.doi.org/10.3126/kumj.v9i1.6266 Kathmandu Univ Med J 2011;9(1):64-8

Surgical Repair versus Conservative Treatment for Moderate Functional Tricuspid Regurgitation in Concomitant with Mitral Valve Surgery

“…Mechanical ventilation, ICU stay, and morbidity were not significant between both groups. Our results agreed with the study of Pradhan and coworkers [3]. Ro and colleagues reported that the operative mortality rate was 1.0%.…”

“…We have found a significant difference in the functional class with better improvement in the repair group. Our results were supported by the study of Pradhan and colleagues who found that at three month's review after surgery, four patients were in NYHA II amongst those without tricuspid repair, whilst the rest were in NYHA I [3]. Additionally, DeMeester and coworkers reported that NYHA functional class was significantly better compared with preoperatively in all patients, at 6 months follow-up [11].…”

“…The cross-clamp time was not significantly different as the tricuspid repair was done after the removal of the cross-clamp. These data were similar to Pradhan and colleagues who found that the DeVega annuloplasty did not significantly prolong the cross-clamp time as compared to those with mitral valve replacement only [3]. However, Ro and colleagues reported that cardiopulmonary bypass and aortic cross-clamp times were significantly longer in the repair group than in the control group [8].…”

“…Similarly, Gürsoy and coworkers have studied 66 patients with mild tricuspid insufficiency who underwent mitral valve replacement without addressing the TV and revealed that mild FTR might advance to moderate (24.2%) or severe (27.3%) grade in more than half of the patients [1]. Furthermore, Pradhan and colleagues studied 43 patients with moderate functional TR who underwent mitral valve surgery and found that eleven (47.8%) patients in the DeVega group and only five (25%) of the non-repair group had a trace or less TR with a significant difference between both groups [3].…”

“…Most of the studies on the FTR investigated the role of concomitant tricuspid (TV) repair at the time of the initial mitral valve surgery in the presence of severe FTR. The aim of concomitant tricuspid valve repair is the prevention of progression of tricuspid regurgitation (TR) and right-side heart failure, and the current recommendation is to repair severe TR; however, moderate TR is controversial [3].…”