Khaled D Algarni1, Juan Alfonso2, Claudio Pragliola2, Hatim Kheirallah2, Adam I Adam2, Amr A Arafat3. 1. Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia. Electronic address: khaledga999@hotmail.com. 2. Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia. 3. Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia; Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
Abstract
BACKGROUND: The ideal tricuspid valve annuloplasty (TVA) prosthesis is controversial. This study aimed to compare the effect of rigid versus flexible TVA prostheses on long-term outcomes after repair of functional tricuspid regurgitation (FTR). METHODS: We included 713 patients who had repair of FTR from 2009 to 2017. Patients were divided into 2 groups according to the type of TVA prosthesis. Group 1 (n = 104) included patients who had repair using rigid rings; group 2 (n = 609) included patients with flexible bands. Median age was 53.5 years (25th through 75th percentiles; range, 42.5-62 years) in group 1 versus 56 years (range, 45-65 years) in group 2 (P = .11). Propensity score matching identified 91 matched pairs for comparison. RESULTS: In the matched pairs, operative mortality was identical (4 in both groups [4.4%]; P ˃ .99). Median follow-up was 55 months (range, 28-83 months). The cumulative incidence of moderate or higher tricuspid regurgitation (TR) in the presence of death as a competing risk was higher in group 2 (subdistribution hazard ratio = 1.63, P = .019; and subdistribution hazard ratio = 1.6, P = .099 before and after matching, respectively). There was a trend of higher pacemaker insertion in group 1 (7 [7.69%] versus 3 [3.3%]; P = .34), which did not reach statistical significance after matching. There was no significant change in the degree of TR over time between groups (odds ratio = 1.21, P = .53; and odds ratio = 1.75, P = .21 before and after matching, respectively). CONCLUSIONS: Both types of TVA prostheses had comparable efficacy in managing FTR; however, freedom from moderate or more TR was higher in the rigid ring group.
BACKGROUND: The ideal tricuspid valve annuloplasty (TVA) prosthesis is controversial. This study aimed to compare the effect of rigid versus flexible TVA prostheses on long-term outcomes after repair of functional tricuspid regurgitation (FTR). METHODS: We included 713 patients who had repair of FTR from 2009 to 2017. Patients were divided into 2 groups according to the type of TVA prosthesis. Group 1 (n = 104) included patients who had repair using rigid rings; group 2 (n = 609) included patients with flexible bands. Median age was 53.5 years (25th through 75th percentiles; range, 42.5-62 years) in group 1 versus 56 years (range, 45-65 years) in group 2 (P = .11). Propensity score matching identified 91 matched pairs for comparison. RESULTS: In the matched pairs, operative mortality was identical (4 in both groups [4.4%]; P ˃ .99). Median follow-up was 55 months (range, 28-83 months). The cumulative incidence of moderate or higher tricuspid regurgitation (TR) in the presence of death as a competing risk was higher in group 2 (subdistribution hazard ratio = 1.63, P = .019; and subdistribution hazard ratio = 1.6, P = .099 before and after matching, respectively). There was a trend of higher pacemaker insertion in group 1 (7 [7.69%] versus 3 [3.3%]; P = .34), which did not reach statistical significance after matching. There was no significant change in the degree of TR over time between groups (odds ratio = 1.21, P = .53; and odds ratio = 1.75, P = .21 before and after matching, respectively). CONCLUSIONS: Both types of TVA prostheses had comparable efficacy in managing FTR; however, freedom from moderate or more TR was higher in the rigid ring group.