Objective. The mechanism of functional tricuspid regurgitation is a cascade of pathological processes caused by the pathology of the left chambers of the heart, and to a large extent by the pathology of the mitral valve. In most cases, annuloplasty is sufficient for correction.
Material and methods. In the Department of Emergency Surgery of Acquired Heart Diseases of Bakoulev National Medical Research Center for Cardiovascular Surgery for the period from January 2010 to December 2015 were performed 999 tricuspid valve annuloplasty procedures. Of these, interventions for moderate and severe functional tricuspid insufficiency were performed in 512 patients. In 349 patients, suture annuloplasty was used, in 163 cases – ring annuloplasty (a band of PTFE). There were created 2 comparable groups of 100 patients in each after propensity score matching.
Results. Hospital mortality in the suture annuloplasty group was 8%, in the band annuloplasty group – 9% (p = 0.8001). There were achieved statistical significance in the average tricuspid regurgitation at the time of discharge between the groups which was amounted to 0.7 ± 0.1 in the suture annuloplasty group and 0.5 ± 0.1 in the band annuloplasty group (p = 0.0260). The average time of observation in the suture annuloplasty group was 62.8 ± 13.8, in the band annuloplasty group – 59.4 ± 13.3 (p = 0.5027). Long-term mortality was 19 (24.4%) patients in the suture annuloplasty group, and 20 (24.1%) patients in the band annuloplasty group (p = 0.4750). The difference between groups in late return of tricuspid regurgitation ≥ II degrees was obtained, which was amounted to 32.2% (19 patients) in the suture annuloplasty group and 19.0% (12 patients) in the band annuloplasty group with a tendency to statistical significance (p = 0.0818). In the band annuloplasty group the independent risk factor for the late return of tricuspid regurgitation ≥ II degrees was atrial fibrillation (odds ratio (OR) 1.8 [0.39–8.27], p = 0.3893. In the suture annuloplasty group the independent predictors of the late return of tricuspid regurgitation ≥II degrees were the preoperative diameter of the tricuspid valve ring more than 40 mm (OR 2.09 [0.52–8.46], p=0.1830), the preoperative decrease ejection fraction of the left ventricle less than 50% (OR 4.73 [0.39–57.7], p = 0.0578), atrial fibrillation (OR 1.8 [0.44–7.31], p = 0.3268) and the presence of pacemaker electrodes at the time of discharge (OR 4.73 [0.39–57.7], p = 0.0578).
Conclusion. Hospital and long-term mortality doesn’t differ depending on the annuloplasty method. Suture and ring techniques provide good immediate results. Proposed new device for ring annuloplasty is a safe, effective, feasible method of treating functional tricuspid insufficiency. Compared to the suture method, in 5 years after the operation, the ring method shows more reliable and stable results regarding to the freedom from the return of tricuspid regurgitation ≥II degrees (81% in the band group and 67.8% in the suture group). In the cases of severe preoperative tricuspid annulodilation, the presence of pacemaker electrodes and a decrease in the initial left ventricular ejection fraction, preference should be given to ring annuloplasty. However, even when using the ring method of annuloplasty in 19% of cases is observed returns of the tricuspid regurgitation, which indicates that isolated annuloplasty not enough, in some cases, in the treatment of functional tricuspid valve disease.
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About the authors
- Bagrat V. Kazumyan, Cardiovascular Surgeon, ORCID
- Ravil M. Muratov, Dr. Med. Sc., Professor, Head of Department, ORCID
- Natal’ya N. Soboleva, Cand. Med. Sc., Ultrasound Diagnostician