Key result
Flexible ring annuloplasty is linked to similar 10-year TR recurrence compared to rigid rings.
Why the study?
The optimal annuloplasty ring choice for functional tricuspid regurgitation remains unclear, as relevant studies have exhibited bias or had limited long-term follow-up.
Does flexible ring annuloplasty reduce 10-year cumulative TR recurrence compared to rigid ring annuloplasty in patients with functional tricuspid regurgitation?
Cohort (n=362)
No
Does flexible ring annuloplasty reduce 10-year cumulative TR recurrence compared to rigid ring annuloplasty in patients with functional tricuspid regurgitation?
Hazard Ratio: 0.82
Absolute Event Rate: 18.9% vs 15.1%
p-value: p=0.60
Flexible and rigid ring annuloplasty for functional tricuspid regurgitation demonstrate comparable 10-year outcomes, including TR recurrence and survival, though limited power precludes definitive equivalence.
Rigid rings may lower TR recurrence risk; leaves open optimal annuloplasty choice pending RCTs.
Background Functional tricuspid valve (TV) disease progression and reoperation risk can be reduced through concomitant TV repair during left‐sided cardiac surgery. However, the optimal annuloplasty ring choice remains unclear; relevant studies have exhibited bias or had limited long‐term follow‐ups. This study compared the short‐term and long‐term outcomes of flexible and rigid ring annuloplasty in patients with functional tricuspid regurgitation (TR). Materials and Methods We recruited 615 patients who underwent tricuspid surgery from 2008 to 2020. Patients with primary TR, suture annuloplasty, or valve replacement were excluded. We adopted inverse probability of treatment weighting (IPTW) to balance baseline variables, reducing bias. The primary endpoint was 10‐year cumulative TR recurrence; the secondary endpoints were left‐heart redo surgery, right ventricular dysfunction, cardiac‐related mortality, and overall survival. Results The final cohort comprised 277 and 85 patients receiving rigid ring and flexible ring annuloplasty, respectively. After IPTW adjustment, no significant differences were observed in short‐term outcomes in those with moderate TR (aOR = 0.78, 95% CI: 0.39–1.58) or severe TR (aOR = 0.47, 95% CI: 0.16–1.33). The groups demonstrated comparable 10‐year cumulative incidences of TR recurrence (15.1% rigid vs. 18.9% flexible; sHR = 0.82, p = 0.60), redo left‐heart surgery (19.4% vs. 26.6%; sHR = 0.76, p = 0.46), right ventricular dysfunction (9.4% vs. 19.6%; sHR = 0.46, p = 0.07), and cardiac‐related mortality (12.3% vs. 10.8%, sHR = 1.10, p = 0.86). The overall survival rates were also similar (75.4% vs. 83.3%, p = 0.34). Conclusion In this single‐center retrospective cohort adjusted by IPTW, flexible and rigid ring annuloplasties were associated with similar short‐term and long‐term outcomes; however, residual confounding and limited power, particularly in the flexible‐ring group, preclude definitive claims of equivalence.
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Huang et al. (2026) conducted a cohort in Functional tricuspid regurgitation (n=362). Flexible ring annuloplasty vs. Rigid ring annuloplasty was evaluated on 10-year cumulative TR recurrence (sHR 0.82, p=0.60). Flexible ring annuloplasty was associated with a similar 10-year cumulative incidence of tricuspid regurgitation recurrence compared to rigid rings (18.9% vs 15.1%; sHR 0.82, p=0.60).
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