Key result
A combination of subvalvular procedures for functional tricuspid regurgitation yielded a 71.4% rate of freedom from death and moderate TR at 2 years, compared to 41.7% for a single procedure (p=0.39).
Why the study?
To evaluate the outcomes of patients undergoing subvalvular procedures for functional tricuspid regurgitation with severe leaflet tethering.
Do subvalvular procedures combined with ring annuloplasty improve TR grades and tethering height in patients with functional tricuspid regurgitation and severe leaflet tethering?
Cohort (n=17)
No
Do subvalvular procedures combined with ring annuloplasty improve TR grades and tethering height in patients with functional tricuspid regurgitation and severe leaflet tethering?
Subvalvular procedures combined with ring annuloplasty effectively reduce TR grade and tethering height in patients with functional TR and severe leaflet tethering, with combination procedures potentially offering more durable results.
Subvalvular repair plus annuloplasty was associated with predischarge TR improvement; leaves open durability advantage of combination over annuloplasty alone.
OBJECTIVES: The goal of this study was to evaluate the outcomes of patients with subvalvular procedures for functional tricuspid regurgitation (TR) with severe leaflet tethering. METHODS: Of 175 patients who had tricuspid valve surgery between June 2016 and June 2021, a total of 17 patients with functional TR with a preoperative tethering height ≥8 mm underwent subvalvular procedures (annular repositioning [An-Rep]) to reduce septal leaflet tethering, papillary muscle relocation to reduce anterior leaflet tethering, and/or papillary muscle bundling [PMB] to reduce anterior and posterior leaflet tethering along with ring annuloplasty at our institution. A single subvalvular procedure was performed in 9 patients (An-Rep in 5 patients, PMB in 4 patients; group S), and a combination of subvalvular procedures was performed in 8 patients (An-Rep and papillary muscle relocation in 5 patients, An-Rep and PMB in 3 patients; group C). RESULTS: Predischarge TR grades and tethering height were significantly improved (3.2 ± 1.3-1.0 ± 0.5, p = 0.001; 9.9 ± 2.5 mm-5.5 ± 2.8 mm, p < 0.001, respectively). An-Rep and PMB significantly reduced the postoperative closing angles of the septal and anterior leaflets, respectively. During the 20.4 ± 19.5-month follow-up period, the rates of freedom from death and moderate TR at 2 years were 41.7% in group S, and 71.4% in group C (p = 0.39), respectively. In group C, TR recurrence was not observed at 2 years postoperatively. CONCLUSIONS: Subvalvular procedures were effective in reducing the predischarge TR grades and tethering height. The combination of subvalvular procedures might be a durable strategy to prevent recurrent TR.
No takes yet. Share an insight, caveat, or question.
Takeshita et al. (2022) conducted a cohort in Functional tricuspid regurgitation with severe leaflet tethering (n=17). Combination of subvalvular procedures vs. Single subvalvular procedure was evaluated on Freedom from death and moderate TR at 2 years (p=0.39). A combination of subvalvular procedures for functional tricuspid regurgitation yielded a 71.4% rate of freedom from death and moderate TR at 2 years, compared to 41.7% for a single procedure (p=0.39).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: