211277 Association of edge-to-edge valve repair with artificial ring annuloplasty for severe tricuspid insufficiency

/Liu Keye(柳克曄，Dept Cardiac Surg，Affil Hosp Hebei Univ，Baoding 071000)…∥Chin J Thorac Cardiovasc Surg.-2011，27(4).-200 ～203

ObjectiveTo analyze whether association of edge to edge valve repair with artificial ring annuloplasty would result in better results in patients with severe tricuspid regurgitation(TR).MethodsFrom April，2001 to May，2010，41 patients underwent tricuspid valve repair to treat severe TR were studied.Twenty-one patients were done artificial ring annuloplasty alone(group R)and twenty patients were done artificial ring annuloplasty associated with edge to edge valve repair(group E).All the patients received echocardiography before surgery，before discharge and in mid and long-term follow-up.The ratio between TR jet area(TRA)and right atrial area(RAA)was used to quantitatively evaluate the seriousness of TR.Movement of tricuspid valve leaflets，tricuspid valve orifice area，pulmonary artery pressure(PAP)，left ventricular ejection fraction(LVEF)were observed to evaluate heart function.ResultsAt discharge in group R，no or trivial TR was presented in 7 patients，mild TR in 12 patients and moderate TR in 2 patient.Bad apposition of the free edges of anterior and septal leaflets was observed in paients with mild and moderate TR.While in group E，no or trivial TR was presented in 13 patients and mild TR in 7 patients.The follow-up ranged from 6 months to 100 months［average(54.8 ±26.7)months］.In group R，no or trivial TR was present in 5 patients，mild TR in 11 patients，moderate TR in 4 patients and severe in 1 patient.Bad apposition of the free edges of anterior and septal leaflets was observed in paients with mild to severe TR.Redo tricuspid valve repair was done in one patient in group R for recurrent severe TR and the edge-to-edge valve repair was utilized.In group E，no tricuspid stenosis was found.No or trivial TR was presented in 10 patients，mild TR in 9 patients and moderate TR in 1 patient.The ratio of TRA/RAA of group R was significantly higher than that of group E(0.25 ± 0.16 vs.0.13 ± 0.10，P ＜ 0.01).ConclusionAssociation of edge-to-edge valve technique with artificial ring annuloplasty was safe and effective for treatment of severe tricuspid regurgitation due to bad apposition of free edges of tricuspid leaflets and dilatation of tricuspid annulus，.It could decrease the incidence of residual tricuspid regurgitation and prevent the recurrence of severe tricuspid regurgitation.9 refs，1 tab.