Outcome of MC3 Ring Annuloplasty for Functional Tricuspid Regurgitation
Condition: Functional Tricuspid Regurgitation
MeSH terms: Tricuspid Valve Insufficiency
Study type: Observational [Patient Registry]

Summary: 
      This study includes 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 underwent ring annuloplasty with Edward MC3 rings were
      compared to another group of 82 patients underwent standard suture (DeVega) repair. The
      primary outcome was residual TR (≥ moderate TR).
    

Detailed description: 
      This study evaluated early and midterm outcomes after operations for TV repair which were
      performed at our institution, between January 2016 and December 2018. The mean follow-up
      duration was 18.84±9.90 months (range: 3-33 months). The study included 105 patients who
      underwent repair for FTR during mitral valve replacement for rheumatic valve disease. There
      were 82 patients underwent suture (DeVega) repair and 23 patients underwent ring annuloplasty
      using Edward MC3 incomplete 3D ring. The indications of surgery for FTR were: (1) severe TR;
      or (2) moderate TR with annular dilatation greater than 40 mm and/or preoperative systolic
      pulmonary artery pressure (SPAP) >50 mmHg. We excluded patients with non-rheumatic mitral
      disease, combined mitral and aortic valve replacement, mitral valve repair, concomitant
      coronary artery or aortic surgery, mild or organic tricuspid regurgitation, emergency
      surgery, reoperations or missed data. Based on echocardiographic data, the severity of TR was
      graded as: 0 (no TR), 1+ (mild TR), 2+ (mild to moderate TR), 3+ (moderately severe TR), or
      4+ (severe).

      The type of tricuspid valve repair was chosen in according to surgeon's preference and
      echocardiographic criteria of TV. The DeVega repair was performed when the patient had
      minimal annular dilation and lower severity of pulmonary hypertension, while ring
      annuloplasty was performed in patients with severe tricuspid annular dilation and severe
      pulmonary hypertension. The DeVega repair was performed on a beating heart using
      pledget-supported two 4-0 polypropylene running parallel sutures. The MC3 ring annuloplasty
      was performed through right atriotomy using cardiopulmonary bypass and cardioplegic arrest.
      The ring size was determined after measurement of the length of the attachments of the
      tricuspid septal leaflet (the distance between the anteroseptal and septoposterior
      commissures) or the surface area of the anterior leaflet. The chosen ring was undersized by
      at least one size. The ring was implanted from the anteroseptal commissure to the middle of
      the septal leaflet. A series of 8 to10 mattress sutures with a 2-0 Ethibond multifilament
      suture were made on the tricuspid annulus starting from the center of the septal annulus to
      the anteroseptal commissure in the counter-clockwise direction, to avoid the atrioventricular
      conduction tissue. Thereafter, the sutures were placed through the sewing ring of the
      prosthesis , followed by lowering and securing of the ring to the annulus The collected
      pre-operative data included age, sex, New York Heart Association (NYHA) functional class, ,
      and the type of preoperative mitral valve disease. The primarily assessed post-operative
      outcome was residual TR (≥ moderate TR; ≥ grade +2). Other assessed pre- and post-operative
      parameters included NYHA functional class, and echocardiographic data regarding grade of TR,
      SPAP, tricuspid annulus (TA) diameter, tricuspid annular plane systolic excursion (TAPSE),
      left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), left
      ventricular end-systolic dimension (LVESD), and left ventricular ejection fraction (LVEF).
    

Intervention name(s): tricuspid valve repair
Intervention type(s): Procedure
Intervention description(s): Tricuspid valve repair during mitral valve replacement for rheumatic heart disease using suture (DeVega) repair or ring annuloplasty
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Adult patients who underwent repair for functional tricuspid regurgitation during mitral
        valve replacement for rheumatic valve disease
      
Keywords: Tricuspid valve; Functional tricuspid regurgitation; Suture annuloplasty; Ring annuloplasty