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Mid-term Outcomes of Suture Annuloplasty versus Ring Annuloplasty for Functional Tricuspid Regurgitation
Hiroki Hata, Tomoyuki Fujita, Yusuke Shimahara, Shunsuke Sato, Junjiro Kobayashi.
National Cerebral and Cardiovascular Center, Suita, Japan.

OBJECTIVE: There are some good evidences supporting ring annuloplasty over suture annuloplasty for patients with functional tricuspid regurgitation (TR). However, it is still controversial whether there is a significant difference in surgical outcome between the two techniques. The purpose of this study was to compare the mid-term results of tricuspid annuloplasty (TAP) with or without an annuloplasty ring.
METHODS: From January 1996 to May 2013, 558 patients (mean age, 64.7±9.1 years, 59.6% women) underwent TAP for functional TR at our institution, of whom 324 underwent conventional suture annuloplasty with De Vega or Kay technique and the other 234 underwent ring annuloplasty (flexible ring, 59; rigid ring, 175). Transthoracic echocardiography was performed before and 1 week after operation and in the follow-up period. The severity of TR was graded from 0 to 4. The clinical data were retrospectively collected and statistically analyzed.
The mean follow-up period was 72.4 (1-208) months. Suture annuloplasty patients were younger (62.9 versus 67.3). Other preoperative characteristics and operative parameters were similar between the two groups. There was no significant difference in the overall survival (suture 96.7% versus ring 98.2% at 1 year, 89.7% vs 91.5% at 5 years, 83.4% vs 87.6% at 10 years, respectively) and freedom from recurrent moderate to severe TR (99.6% vs 99.1% at 1 year, 96.6% vs 86.6% at 5 years, 84.9% vs 81.1% at 10 years, respectively) between the groups; however TR grade was significantly better in the ring group at discharge (1.2 +/- 0.9 vs 0.9 +/- 0.8) and follow-up (1.6 +/- 0.9 vs 1.1 +/- 0.8). Multivariate analysis revealed that suture annuloplasty (odds ratio 3.45), prior cardiac surgery (odds ratio 2.60) and preoperative severe TR (odds ratio 3.51) were the predictors of recurrent TR. There was no significant difference in mid-term outcomes between the patients with a flexible ring and a rigid ring.
In conclusion, both suture and ring annuloplasty provide acceptable mid-term survival and stable postoperative regurgitation grade. Suture annuloplasty, prior cardiac surgery and preoperative severe TR were the risk factors of recurrent TR.

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