Suture Bicuspidization of the Tricuspid Valve Versus Ring Annuloplasty for Repair of Functional Tricuspid Regurgitation: Mid-Term Results of 257 Consecutive Patients
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Objective: Bicuspidization of the tricuspid valve may be performed by placement of a double multifilament braided suture along the posterior annulus obliterating the posterior leaflet. This technique is more rapid than ring annuloplasty with decreased operative time. In this study, we review and compare our experience with bicuspidization and ring tricuspid annuloplasty for repair of functional tricuspid regurgitation (TR).
Methods: From 1999 to 2003, 237 patients (mean age 67 + 14 years) underwent bicuspidization (n=157) and ring (n=80) tricuspid annuloplasty for functional TR during repair or replacement of left-sided valve lesions at our institution. Of the ring annuloplasty patients, 75% (60/80) received a Cosgrove-Edwards flexible band, 16% (13/80) a Carpentier-Edwards ring, and 9% (7/80) a Carbomedix Annuloflex ring. Follow-up information was obtained on 205 (86%) patients with a mean follow-up time of 2.6 years. Preoperative and postoperative transthoracic echocardiograms (TTEs) were assessed for TR and graded on a 4-point scale (1=trace, 2=mild, 3=moderate, 4=severe). Time to development of 3+ TR was evaluated by Kaplan-Meier analysis. Multivariate analysis of preoperative and 2 year postoperative TR was done by repeated measures general linear model.
Results: There was no significant difference in preoperative TR between both groups (p=0.08). Both techniques provided equal efficacy (Table 1). At 2 years postoperatively, 75% (98/131) of bicuspid annuloplasty and 69% (50/72) of ring annuloplasty patients had zero to mild residual TR. There was no statistically significant difference between the two groups at 2 years (p=.18). Of the different ring annuloplasty techniques, however the Carpentier-Edwards ring demonstrated a trend to improved residual TR compared with the Cosgrove-Edwards flexible band and bicuspidization. At 2 years postoperatively, mean TR was 1.4 + 1.3 for the ring and 2.1 + 1.0 for the band.
Conclusions: Bicuspidization annuloplasty and ring annuloplasty were equally effective at eliminating moderate to severe TR in 69-75% of patients at 2 years postoperatively.
| Bicuspidization | Ring |
| % patients Mod-Severe TR | Mean TR | Δ from preop | p | % patients Mod-Severe TR | Mean TR | Δ from preop | p |
| Preoperative | 95%
(149/157) | 3.4 (+0.6) | | | 98%
(78/80) | 3.5 (+0.5) | | |
| Two years Postoperative | 25%
(33/131) | 2.0 (+1.0) | -40% | <.05 | 31%
(22/72) | 2.1 (+1.1) | -40% | <.05 |
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