Surgical Tricuspid Valve Reconstruction with a New 3 Dimensional Ring: Improved 1 Year Outcome

Objectives: Three-dimensional, anatomically shaped remodeling rings were recently introduced to improve functional results of surgical tricuspid annuloplasty (TVR) for correction of hemodynamically relevant insufficiency. We analyzed results achieved with such a ring (3D-contour, Medtronic) and compared them to those of a matched patient population where a two-dimensional “Physio” ring was used.

Material and methods: Since February 2013 3D Contour rings were implanted in 50 patients (Gr.1; 46% female, age 68.5 ± 11.9 years) with high grade functional tricuspid regurgitation (TR) . We compared this group with an age, gender and preoperative diagnoses matched group of 50 patients who received a Physio Tricuspid ring (Edwards) (Gr.2; 42.6% female, age 69.0 ± 9.2 years) focusing on functional and echocardiographic results at discharge and 1-year-follow-up. Preoperative characteristics were similar in both groups with regards to atrial fibrillation (76.1% versus 85.2%), mean NYHA score (2.7 ± 0.5 versus 2.9 ± 0.4)),and mean TR (3.3 ± 0.7 vs 2.9 ± 0.68) in Gr.1 versus Gr.2 . Preoperative RV function was moderately reduced in 42%in Gr.1 and 34% in Gr.2.n Gr.1 TVR was combined with mitral valve surgery in 84.0%, isolated TVR performed in 10.0%, in group 2 all patients had concomitant mitral valve surgery. Additional CABG, AVR and closure of ASD was performed in isolated patients of both groups. 1-year follow-up was 100% complete in both groups.

Results: Postoperative echo at dischargeshowed competent valves withoutany TR in 89% in Gr.1 and 81´% in Gr.2, with all other patients with TR ≤ 1. At 1 year follow-up mean TR was 1.7 ± 0.3 versus 2.2 ± 0.4 (p = 0.058) and mean NYHA score 1.7 ± 0.5 versus 2.3 ± 0.6 (p = 0.06) in Gr.1 versus Gr 2. respectively. RV function improved in Gr.1and remained stable in Gr.2 (moderate dysfunction 26% versus 36% Gr.1 versus Gr.2)

Concomitant atrial ablation was performed significantly more often in Gr. 2 (76.8% versus 40.5% in Gr.1; p < 0.05), incidence of postoperative permanent pacemaker implantation was not significant different between groups (43.8% versus 48.4%; Gr. 1 versus 2) nor was overall MACE at 1 year follow up.

Conclusion: Both tricuspid rings showed excellent repair results at discharge. At 1 year follow-up, patients in the 3D Contour ring group tended to show lesser degree of TR, better RV function and lower NYHA scoring.