Surgical management of functional tricuspid regurgitation with a new remodeling annuloplasty ring

Abstract

Background: Moderate-to-severe functional tricuspid regurgitation (TR) should be corrected in patients undergoing surgery for left-sided valvular diseases, to improve long-term outcomes. Several techniques of surgical repair (suture annuloplasty or prosthetic annuloplasty) to correct this condition have been described. Multiple clinical studies have shown the superiority of prosthetic remodeling annuloplasty over the other surgical approaches. Despite this, suture-based annuloplasty remains the most commonly used technique for tricuspid valve repair. A new 3-dimensional remodeling prosthesis has been developed to address the issue of residual TR. We report our early experience with this new 3-dimensional prosthetic remodeling ring, the Edwards MC 3 system.

Material: From August 2002 to March 2004, 51 patients (24 male, 27 female, mean age 64 +/- 15, ejection fraction 49 +/- 15, median NYHA III [II-IV]) underwent tricuspid valve repair for functional TR due to annular dilatation, with the Edwards MC 3 system. Etiology of left-sided valvular disease was: rheumatic (n = 19), degenerative (n = 16), ischemic cardiomyopathy (n = 1), and endocarditis (n = 5). Twenty (50%) patients underwent redo operations. Concomitant procedures included: mitral valve surgery (repair n = 34, replacement n = 14), aortic valve replacement (n = 5), coronary artery bypass graft (n = 8) and left arterial maze (n = 16). Median EuroSCORE was 12% (1-74%) in this patient population.

Results: Operative and late mortality were 3.8% (n = 2) and 13.7% (n = 7), respectively. Echocardiography at discharge showed a mean TR decrease from 3.1 +/- 0.9 to 0.3 +/- 0.4 (p < 0.001) and mean mitral regurgitation (MR) decrease from 3.2 +/- 1 to 0.1 +/- 0.1 (p < 0.001), while ejection fraction increased to 53% (p = 0.047), and at 6-month follow-up, mean TR and MR remained unchanged.

Conclusion: Concomitant tricuspid valve repair for functional TR with left-sided valve surgery carries a low operative mortality. The Edwards MC 3 annuloplasty system is relatively simple to implant and corrects TR effectively (without significant residual TR), while providing excellent short-term clinical results. The 3-dimensional saddle shape of this ring may further optimize the fixation of the annulus in systolic position, and improve long-term results. Larger clinical series with longer-term follow-up are necessary to confirm these early promising results.