January 1, 2014Annals of Thoracic and Cardiovascular SurgeryOpen Access

Long-Term Outcomes of Tricuspid Annuloplasty for Functional Tricuspid Regurgitation Associated with Degenerative Mitral Regurgitation: Suture Annuloplasty Versus Ring Annuloplasty Using a Flexible Band

Q: What are the key findings of this study?

Concomitant tricuspid ring annuloplasty using flexible bands significantly improved long-term freedom from moderate or greater tricuspid regurgitation compared to suture annuloplasty.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Functional tricuspid regurgitation associated with degenerative mitral regurgitation (n=162). Intervention: Ring tricuspid valve annuloplasty using a flexible band vs. Suture tricuspid valve annuloplasty. Primary outcome: 5-year freedom from ≥moderate tricuspid regurgitation (HR 10.66, 95% CI 3.666-31.03, p=<0.001).

Q: What does this research mean for the field?

Concomitant tricuspid annuloplasty using flexible bands provides superior long-term durability and freedom from moderate or greater tricuspid regurgitation compared to suture annuloplasty. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To compare the long-term clinical outcomes and durability of flexible ring versus suture tricuspid annuloplasty for functional tricuspid regurgitation in patients undergoing surgery for degenerative mitral regurgitation.

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Key result

Flexible ring annuloplasty linked to ~27% greater absolute 5-year freedom from ≥moderate TR versus suture.

HR 10.66
95% CI 3.666-31.03
P<0.001
n=162

Why the study?

Does flexible ring tricuspid valve annuloplasty prevent postoperative tricuspid regurgitation progression compared to suture annuloplasty in patients undergoing surgery for degenerative mitral regurgitation?

Population

162 patients who underwent concomitant tricuspid valve annuloplasty for functional tricuspid regurgitation…

Comparison

Flexible ring tricuspid valve annuloplasty using… vs Suture tricuspid valve annuloplasty using Kay or…

Design

Cohort

Follow-up

mean 5.3 ± 5.1 years

Authors

TMTakashi MurashitaSaint Louis University YOYukikatsu OkadaValve (United States)HKHideo KanemitsuKitano Hospital

Discussion

Member takes

Implication

Supports flexible over suture annuloplasty for durable TR control in mitral surgery; leaves open randomized confirmation before practice change.

Key Points

To compare the long-term clinical outcomes and durability of flexible ring versus suture tricuspid annuloplasty for functional tricuspid regurgitation in patients undergoing surgery for degenerative mitral regurgitation.
Retrospective review of patients who received flexible ring tricuspid annuloplasty (n = 120) or suture tricuspid annuloplasty (n = 42) concomitant with degenerative mitral regurgitation surgery.
Assessed outcomes over a mean follow-up of 5.3 ± 5.1 years in a cohort with a mean age of 62.5 ± 13.1 years.
Thirty-day mortality was 0% in the suture group versus 0.8% in the ring group, with lower tricuspid regurgitation grade at discharge in the ring group (p = 0.002).
Freedom from moderate or severe tricuspid regurgitation was significantly higher in the ring group (log-rank p = 0.003), while overall survival and major adverse cardiac and cerebrovascular events did not differ between groups.
Univariate analysis identified suture annuloplasty and preoperative tricuspid regurgitation grade as risk factors for recurrent moderate or greater tricuspid regurgitation, with no reoperations occurring in either group.

Study Design

Type

Cohort (n=162)

Multicenter

Structured PICO

Population

162 patients (mean age 62.5 years, 42% female) with functional tricuspid regurgitation associated with degenerative mitral regurgitation who underwent concomitant tricuspid annuloplasty, followed for a mean of 5.3 years.

Intervention

Flexible ring tricuspid valve annuloplasty (n=120) using Duran or Tailor flexible bands.

Comparator

Suture tricuspid valve annuloplasty (n=42) using Kay or De Vega sutures.

Outcome

Long-term outcomes including survival, freedom from major cardiac/cerebrovascular adverse events, and freedom from ≥moderate tricuspid regurgitation.surrogate

Main Result

Hazard Ratio: 10.66 (95% CI 3.666–31.03)

Absolute Event Rate: 88.1% vs 61.6%

p-value: p=<0.001

Concomitant tricuspid annuloplasty using flexible bands offers improved durability over suture annuloplasty for preventing postoperative tricuspid regurgitation progression in patients undergoing degenerative mitral regurgitation surgery.

Limitations

Single-institution, retrospective review predisposing to biases
Clinical and postoperative echocardiography follow-up was not completed in all cases
Tricuspid annular diameter was not measured intraoperatively
Right atrial and ventricular dimensions and degree of TV leaflet tethering were not studied
Technical ability of reproducibly quantifying TR could have altered over the course of the study
Single-institution, retrospective review of collected data
Clinical and postoperative transthoracic echocardiography follow-up was not completed in all cases
Did not intraoperatively measure the tricuspid annular diameter
Technical ability of reproducibly quantifying TR could have been altered over the course of this study

Cite This Study

Murashita et al. (2014) conducted a cohort in Functional tricuspid regurgitation associated with degenerative mitral regurgitation (n=162). Ring tricuspid valve annuloplasty using a flexible band vs. Suture tricuspid valve annuloplasty was evaluated on 5-year freedom from ≥moderate tricuspid regurgitation (HR 10.66, 95% CI 3.666-31.03, p=<0.001). Concomitant tricuspid ring annuloplasty using flexible bands significantly improved long-term freedom from moderate or greater tricuspid regurgitation compared to suture annuloplasty.

synapsesocial.com/papers/6aa5116410877e4fda94f212 https://doi.org/10.5761/atcs.oa.13-00292

Topics

Mitral valve intervention Tricuspid regurgitation

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Implication

Supports flexible over suture annuloplasty for durable TR control in mitral surgery; leaves open randomized confirmation before practice change.

Long-Term Outcomes of Tricuspid Annuloplasty for Functional Tricuspid Regurgitation Associated with Degenerative Mitral Regurgitation: Suture Annuloplasty Versus Ring Annuloplasty Using a Flexible Band

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Long-Term Outcomes of Tricuspid Annuloplasty for Functional Tricuspid Regurgitation Associated with Degenerative Mitral Regurgitation: Suture Annuloplasty Versus Ring Annuloplasty Using a Flexible Band

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider