Comparison of Mid-Term Survival and Recurrence of Tricuspid Regurgitation Following Tricuspid Valve Repair With Ring Versus Suture Bicuspidization Annuloplasty: Implications on Transcatheter Technologies

Abstract

Purpose: Threshold for concomitant repair of tricuspid regurgitation during left-sided heart valve surgery has decreased and TV repair (TVP) trends are increasing nationally. Furthermore, technology in transcatheter TVP mimicking conventional surgical techniques is rapidly developing. However, long-term outcome comparison between different surgical TVP techniques including ring annuloplasty (RA) and suture bicuspidization (SB) are lacking in literature. Methods: From 2012 to 2016, 650 patients underwent TV repair (336 RA and 314 SB) at our institution for primary or functional tricuspid regurgitation (TR). Concomitant aortic valve (AV), mitral valve (MV) or CABG procedures were included. Patients undergoing TV replacement, concomitant aortic procedures, heart transplantation or VAD placement were excluded. Primary endpoints were cumulative survival and freedom from TV insufficiency (defined as at least moderate TR) determined using Kaplan-Meier analysis. Results: There was no statistical difference in terms of age, gender, and most baseline comorbidities, but RA patients were more likely to be dialysis-dependent (2.7% vs 0%) with at- least moderate right ventricular dysfunction (15.5% vs 11.2%; all P<0.05). Perfusion and cross- clamp times were significantly longer among RA patients, but operative mortality, in-hospital outcomes, postoperative length of stay, and mid-term survival were similar between the two groups (all P>0.05). However, SB was associated with significantly lower freedom from TV insufficiency at 1, 5 and 8 years (P<0.05). Conclusions: The superiority of ring annuloplasty over suture bicuspidization annuloplasty for TV repair appeared to be clinically evident in terms of mid-term survival and subsequent risk for significant TV insufficiency. These findings raise concern in the context of emerging transcatheter technologies which mimic the bicuspidization technique.