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(Circulation. 2006;114:I-577 – I-581.)
© 2006 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Tricuspid Valve Repair With an Annuloplasty Ring Results in Improved Long-Term Outcomes

Gilbert H. L. Tang, MD; Tirone E. David, MD; Steve K. Singh, MD; Manjula D. Maganti, MSc; Susan Armstrong, MSc; Michael A. Borger, MD, PhD

From the Division of Cardiovascular Surgery, Toronto General Hospital, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Correspondence to Michael A. Borger, Toronto General Hospital, 4N-451, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4. E-mail michael.borger{at}uhn.on.ca

Background— The purpose of this study was to compare the long-term results of tricuspid valve (TV) repair with or without an annuloplasty ring.

Methods and Results— 702 patients underwent TV repair at our institution (1978 to 2003), of which 493 had, predominantly, a De Vega procedure (no ring) and 209 had an annuloplasty ring (ring). TV pathology was functional (secondary) in 74% of patients. Concomitant procedures consisted of mitral valve surgery in 80% of patients, aortic valve surgery in 33%, and coronary bypass in 14%. Clinical and echocardiographic follow-up data were obtained. Follow-up was 99% complete and was 5.9±4.9 (mean±SD) years long. Ring patients were younger (55±14 versus 59±14 years; P=0.001) and less likely to have coronary artery disease (10% versus 17%; P=0.02), more likely to be female (75% versus 65%; P=0.01) and having had previous cardiac surgery (56% versus 42%; P=0.001). Operative times were similar between the 2 groups. Long-term survival, event-free survival and freedom from recurrent TR were significantly better in the ring group, and there was a trend toward fewer TV reoperations. Multivariable analysis demonstrated that the use of an annuloplasty ring was an independent predictor of long-term survival (hazard ratio [HR], 0.7; 95% confidence interval [CI], 0.5 to 1.0; P=0.03) and event-free survival (HR, 0.8; CI, 0.6 to 1.0; P=0.04).

Conclusions— Placement of an annuloplasty ring in patients undergoing tricuspid valve repair is associated with improved survival and event-free survival.

Key Words: outcomes • tricuspid valve • valve repair

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