TY - JOUR
T1 - Tricuspid valve repair
T2 - Durability and risk factors for failure
AU - McCarthy, Patrick M.
AU - Bhudia, Sunil K.
AU - Rajeswaran, Jeevanantham
AU - Hoercher, Katherine J.
AU - Lytle, Bruce W.
AU - Cosgrove, Delos M.
AU - Blackstone, Eugene H.
AU - Bolling, Steven F.
AU - Carpentier, Alain F.
AU - De Vega, Norberto G.
AU - Accola, Kevin D.
AU - Seitelberger, Rainald
AU - Dreyfus, Gilles D.
N1 - Funding Information:
Supported in part by an education grant from Edwards Lifesciences. Drs McCarthy and Cosgrove have developed annuloplasty rings for tricuspid valve repair (Cosgrove-Edwards, Edwards-MC 3 ).
PY - 2004/3
Y1 - 2004/3
N2 - Objectives: To compare durability of tricuspid valve annuloplasty techniques, identify risk factors for repair failure, and characterize survival, reoperation, and functional class of surviving patients. Methods: From 1990 to 1999, 790 patients (mean age 65 ± 12 years, 51% New York Heart Association functional class III or IV, and mean right ventricular systolic pressure 56 ± 18 mm Hg) underwent tricuspid valve annuloplasty for functional regurgitation using 4 techniques: Carpentier-Edwards semi-rigid ring, Cosgrove-Edwards flexible band, De Vega procedure, and customized semicircular Peri-Guard annuloplasty. Of these patients, 89% had concomitant mitral valve surgery. A total of 2245 follow-up transthoracic echocardiograms were retrieved. Tricuspid regurgitation was analyzed, and risk factors for worsening regurgitation were identified, by multivariable ordinal longitudinal methods. Results: Tricuspid regurgitation 1 week after annuloplasty was 3+ or 4+ in 14% of patients. Regurgitation severity was stable across time with the Carpentier-Edwards ring (P = .7), increased slowly with the Cosgrove-Edwards band (P = .05), and rose more rapidly with the De Vega (P = .002) and Peri-Guard (P = .0009) procedures. Risk factors for worsening regurgitation included higher preoperative regurgitation grade, poor left ventricular function, permanent pacemaker, and repair type other than ring annuloplasty. Right ventricular systolic pressure, ring size, preoperative New York Heart Association functional class, and concomitant surgery were not risk factors. Tricuspid reoperation was rare (3% at 8 years), and hospital mortality after reoperation was 37%. Conclusions: Tricuspid valve annuloplasty did not consistently eliminate functional regurgitation, and across time regurgitation increased importantly after Peri-Guard and De Vega annuloplasties. Therefore, these repair techniques should be abandoned, and transtricuspid pacing leads should be replaced with epicardial leads.
AB - Objectives: To compare durability of tricuspid valve annuloplasty techniques, identify risk factors for repair failure, and characterize survival, reoperation, and functional class of surviving patients. Methods: From 1990 to 1999, 790 patients (mean age 65 ± 12 years, 51% New York Heart Association functional class III or IV, and mean right ventricular systolic pressure 56 ± 18 mm Hg) underwent tricuspid valve annuloplasty for functional regurgitation using 4 techniques: Carpentier-Edwards semi-rigid ring, Cosgrove-Edwards flexible band, De Vega procedure, and customized semicircular Peri-Guard annuloplasty. Of these patients, 89% had concomitant mitral valve surgery. A total of 2245 follow-up transthoracic echocardiograms were retrieved. Tricuspid regurgitation was analyzed, and risk factors for worsening regurgitation were identified, by multivariable ordinal longitudinal methods. Results: Tricuspid regurgitation 1 week after annuloplasty was 3+ or 4+ in 14% of patients. Regurgitation severity was stable across time with the Carpentier-Edwards ring (P = .7), increased slowly with the Cosgrove-Edwards band (P = .05), and rose more rapidly with the De Vega (P = .002) and Peri-Guard (P = .0009) procedures. Risk factors for worsening regurgitation included higher preoperative regurgitation grade, poor left ventricular function, permanent pacemaker, and repair type other than ring annuloplasty. Right ventricular systolic pressure, ring size, preoperative New York Heart Association functional class, and concomitant surgery were not risk factors. Tricuspid reoperation was rare (3% at 8 years), and hospital mortality after reoperation was 37%. Conclusions: Tricuspid valve annuloplasty did not consistently eliminate functional regurgitation, and across time regurgitation increased importantly after Peri-Guard and De Vega annuloplasties. Therefore, these repair techniques should be abandoned, and transtricuspid pacing leads should be replaced with epicardial leads.
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U2 - 10.1016/j.jtcvs.2003.11.019
DO - 10.1016/j.jtcvs.2003.11.019
M3 - Article
C2 - 15001895
AN - SCOPUS:12144288888
SN - 0022-5223
VL - 127
SP - 674
EP - 685
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -