Intermediate-Term Results of Tricuspid Valve Repair Using a Three-dimensional Annuloplasty Ring in Functional Tricuspid Regurgitation

Objectives: Ring annuloplasty is the preferred procedure in patients with tricuspid regurgitation or annular dilatation of the valve. New 3D annuloplasty rings promise to improve leaflet coaptation, hereby improving durability and long-term survival. We present our data on using the 3D Contour annuloplasty ring in a large patients' cohort.

Methods: A cohort of 468 patients who underwent tricuspid valve repair with the Contour 3D ring (Medtronic, Minneapolis, MN) in a concomitant cardiac procedure (82.7% MV, 22.6% AV, and 26.5% CABG) from December 2010 to January 2017 was retrospectively analyzed. Echocardiographic data was obtained from our database and from referring cardiologists. Complete follow-up was achieved in 95% of patients, yielding a cumulative total of 1,217 patient-years and a mean FU of 2.52 ± 2.0 years.

Result: At follow-up 96.1% of patients had no/trivial or mild TR. Risk factors for recurrent moderate to severe TR were LVEF <50%, TAPSE <16 mm, moderate mitral valve regurgitation at follow-up, and a preoperative TV annulus >50 mm. 30-day mortality was 4.7%, significantly differing between electively performed operations (2.7%) and urgent/emergent operations (11.7%). Preoperatively reduced renal function leads to a higher 30-day and overall mortality. Reoperation of the tricuspid valve was required in six patients (1.6%), whereby three patients underwent re-repair. Risk factors for TV related reoperations were preoperative TV annulus over 50 mm, an implanted permanent pacemaker, and postoperative moderate mitral valve regurgitation.

Conclusion: Tricuspid valve repair with the rigid, three-dimensional Contour 3D annuloplasty ring shows low TR reoccurrence and reoperation rates. Risk-factor analysis revealed that early operation and the use of leadless pacemakers may improve the mid-term results.

Publication History

Article published online:
19 February 2021