Abstract 2983: Tricuspid Repair for Functional Regurgitation: Smaller Annuloplasty is Better
Objectives: Risk factors for failure of tricuspid repair are incompletely defined.
Methods: From 1984 to 2008, 327 patients underwent tricuspid repair. Of these, 308 were performed for functional regurgitation. Demographic and longitudinal data were analyzed. The most recent echocardiogram (i.e., the one that occurred at the latest date after surgery) was available for 212/308 (69%). The median time to echo was 1.8 years. Backward selection logistic regression analysis was performed to identify risk factors for failure of repair (moderate or severe tricuspid regurgitation); operative year was forced into the model to account for longer follow-up times for patients who underwent operation early in the series.
Results: 247/308 (80%) of patients underwent concomitant mitral valve operation, and 39/308 (13%) patients underwent triple valve operation. 53/308 (17%) received a DeVega repair; the remainder (255/308) underwent ring annuloplasty. 80% of patients were in NYHA class III or IV heart failure, and 44% were re-do operations. Thirty day mortality was 7%. Tricuspid regurgitation was moderate or severe by follow-up echo in 58/212 (27%). Among factors analyzed in patients who underwent ring annuloplasty, larger annuloplasty sizes (odds ratio 1.2, p-value 0.004), age (odds ratio 1.03, p-value 0.05), and dialysis (odds ratio 3.2, p-value 0.04) were all associated with failure of repair.
Conclusions: In patients who undergo ring annuloplasty for functional regurgitation, larger rings are associated with moderate or severe tricuspid regurgitation on follow-up echo evaluation. Smaller rings should be considered when tricuspid repair is performed.