Twenty-five years' clinical experience with repair of tricuspid insufficiency

Background and aim of the study: Tricuspid regurgitation secondary to pulmonary hypertension due to left-sided heart valve lesions is common. Here, the results are reported of 25 years' experience with three surgical techniques; the De Vega semicircular annuloplasty, the Bex flexible linear reducer, and the Carpentier-Edwards prosthetic ring annuloplasty. Methods: Between 1976 and 2002, 463 patients underwent 478 tricuspid annuloplasty procedures to correct valve regurgitation during associated left-sided valve surgery. Patients were followed prospectively at the Montreal Heart Institute Valve Clinic. Results: A total of 107 patients (23%) underwent the De Vega semicircular annuloplasty, 267 (58%) the Bex flexible linear reducer, and 89 (19%) the Carpentier-Edwards prosthetic ring annuloplasty. Excluding 30-day mortality, the mean 5-, 10- and 15-year patient survival was 82 +/- 4%, 58 +/- 6% and 30 +/- 6% respectively after the De Vega semicircular annuloplasty, 76 +/- 3%, 54 +/- 4% and 36 +/- 6% respectively after the Bex flexible linear reducer, and the mean five-year patient survival was 88 +/- 4% after the Carpentier-Edwards prosthetic ring annuloplasty (p = 0.65, for comparison of the three survival curves). The mean freedom rate from tricuspid repair failure (clinical right heart failure, redo annuloplasty, tricuspid valve replacement at follow up) was 95 +/- 3%, 93 +/- 3% and 72 +/- 8% at 5, 10 and 15 years respectively after the De Vega semicircular annuloplasty, and 97 +/- 1%, 87 +/- 4% and 66 +/- 9% after the Bex flexible linear reducer. The mean freedom rate from repair failure was 94 +/- 3% at five years after the Carpentier-Edwards prosthetic ring annuloplasty (p = 0.18 for comparison of the three freedom from failure curves). Conclusion: All three techniques of tricuspid valve repair resulted in a low rate of failure, and in good patient survival at long-term follow up.