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January 1, 2010Circulation JournalOpen Access

Tricuspid Annuloplasty Using the MC3 Ring for Functional Tricuspid Regurgitation

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Why the study?

Does tricuspid annuloplasty using a 3-dimensional ring improve tricuspid regurgitation and pulmonary pressures in patients with functional tricuspid regurgitation?

Population

103 consecutive patients with functional tricuspid regurgitation undergoing tricuspid valve annuloplasty…

Design

Cohort

Follow-up

mean 26.7±11.2 months

Authors

DJDong Seop JeongSamsung Medical CenterKKKyung Hwan KimHyundai Steel (South Korea)

Discussion

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Implication

Supports 3D ring annuloplasty in functional TR; hypothesis-generating and should not yet change practice.

Key Points

  • To evaluate the mid-term clinical performance and echocardiographic outcomes of the three-dimensional MC3 ring for tricuspid annuloplasty in functional tricuspid regurgitation.
  • Conducted an observational cohort study of 103 consecutive patients (mean age 52±13 years; 63.6% women) undergoing MC3 ring tricuspid annuloplasty between December 2004 and April 2008.
  • Tracked patients for a mean follow-up of 26.7±11.2 months (range 0–52 months) to assess operative complications, mortality, and serial echocardiographic parameters.
  • Predischarge echocardiography showed a significant reduction in tricuspid regurgitation grade from 2.5±0.8 preoperatively to 0.8±0.8 (P<0.001), remaining stable at 0.9±0.8 at a median 15 months.
  • Systolic pulmonary artery pressure decreased significantly from a preoperative mean of 48.4±15.0 mmHg to 33.9±7.9 mmHg postoperatively (P<0.001).
  • Postoperative mortality was 1.0% (n=1, due to cor pulmonale), with zero ring-related complications such as atrioventricular block, ring dehiscence, or thromboembolism.

Structured PICO

Does tricuspid annuloplasty using a 3-dimensional ring improve tricuspid regurgitation and pulmonary pressures in patients with functional tricuspid regurgitation?

P
Population
103 consecutive patients with functional tricuspid regurgitation undergoing tricuspid valve annuloplasty, mean age 52±13 years, 63.6% women, at a single center in Korea. Indications: TR grade ≥1+ with annular dilatation, or systolic pulmonary artery pressure >50 mmHg with annular dilatation.
I
Intervention
Tricuspid annuloplasty using a 3-dimensional annuloplasty ring (Edwards MC3 system), downsized by at least 1 size, performed concomitantly with other indicated cardiac procedures.
O
Outcome
Changes in tricuspid regurgitation (TR) grade and systolic pulmonary artery pressure measured by echocardiography at predischarge and follow-upsurrogate

Tricuspid annuloplasty using a 3-dimensional ring provides significant and stable mid-term reduction in functional tricuspid regurgitation and pulmonary artery pressures.

Limitations

  • Included other disease entities (atrial septal defect, pulmonary embolism) that can cause right ventricular failure and functional TR
  • Retrospective and descriptive design without a randomized comparison group (e.g., De Vega's suture repair)
  • No consensus on indications for tricuspid annuloplasty; performed even in trivial TR if annular dilatation was present, potentially overestimating merits

Cite This Study

Jeong et al. (2010) studied this question.

synapsesocial.com/papers/6a85bb6d9df929a58fadab1dhttps://doi.org/10.1253/circj.cj-09-0231

Topics

Tricuspid regurgitation
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Tricuspid Valve Repair With an Annuloplasty Ring Results in Improved Long-Term Outcomes2006 · 338 citations
  2. 2Progression of Tricuspid Regurgitation After Repaired Functional Ischemic Mitral Regurgitation2005 · 231 citations
  3. 3Tricuspid Valve Tethering Predicts Residual Tricuspid Regurgitation After Tricuspid Annuloplasty2005 · 335 citations
  4. 4Right Ventricular Remodeling and Dysfunction With Subsequent Annular Dilatation and Tethering as a Mechanism of Isolated Tricuspid Regurgitation2008 · 26 citations
  5. 5The tricuspid valve annulus: study of size and motion in normal subjects and in patients with tricuspid regurgitation.1982 · 252 citations