Tricuspid Valve Reconstruction with the Simplici-T Annuloplasty Band Compared to Ring Annuloplasty

Objectives: According to the European guidelines, tricuspid valve (TV) reconstruction especially in combination with left-sided heart surgery is strongly recommended not only in severe (I, C) but also in mild to moderate tricuspid regurgitation (IIa, C). Concerning repair technique and associated prosthesis type, however, no explicit suggestion exists. We therefore aimed to evaluate the use of the annuloplasty band Simplici-T compared with traditional ring annuloplasty.

Methods: A total of 132 patients underwent TV repair at our department between August 2013 and August 2018. Annuloplasty with ring implantation was performed in 62 patients (ring group). Fifty-seven patients received a TV repair with annuloplasty using Simplici-T band (ST group). Patients treated with other reconstruction techniques (n = 23) were excluded from this study. Demographic, operative, and postoperative data were collected and analyzed.

Results: Patients’s demographic and clinical data including age, gender, EuroSCORE II, NYHA classification, and preoperative echo parameters for right ventricular function (tricuspid annular plane systolic excursion, TAPSE) and size (right ventricular end-diastolic dimension, RVEDD) were similar in both groups. Grade of TV regurgitation was significantly higher in the ring group (p = 0.004). Operative data were not significantly different in both groups: the majority of operations in each group was performed as an elective procedure (98% in each group) through full sternotomy (93% ST vs. 94% ring group) on beating heart (54% ST vs. 74% ring group) during a combined operation (96% ST vs. 87% ring group), where the mitral valve was repaired/replaced in most of the cases (79% ST vs. 65% ring group). Procedure times (cardiopulmonary bypass and cross-clamping time) did not differ significantly. Predischarge follow-up echo revealed similar TAPSE scores in both groups, but a significantly lower grade of TV regurgitation in the ST group (p = 0.003). In-hospital mortality was similar in both groups (16% ST vs. 18% ring group).

Conclusion: Our study shows that TV reconstruction with annuloplasty band Simplici-T significantly reduced TV regurgitation compared with annuloplasty with ring implantation in patients who underwent concomitant TV reconstruction. Long-term follow-up is planned to evaluate whether this reduction of TV regurgitation is long-lasting and can ensure a beneficial right heart remodeling leading ultimately to a better right heart performance on the long run.