2-year follow-up after 3D ring annuloplasty for surgical tricuspid valve reconstruction - early and midterm experience in a matched pairs analysis
Sumi Westhofen, Christian Detter, Hermann Reichenspurner, Florian Wagner.
University Heart Center Hamburg, Hamburg, Germany.
OBJECTIVE: Recurrent tricuspid regurgitation (TR) of more than 30% even in the early follow-up period after tricuspid valve annuloplasty (TVR) has been the impulse for further development of reconstructive agents. Three-dimensional, recently introduced anatomically shaped 3D remodeling rings shall improve functional and hemodynamic results of TVR. We analyzed results achieved with a 3D ring and compared them with those of a two-dimensional ring.
METHODS: Since February 2013 3D Contour rings were implanted in 100 patients with high grade functional tricuspid regurgitation (TR). We compared this group with an age, gender and preoperative diagnoses matched group of 100 patients who received a 2D Physio Tricuspid ring focusing on functional and echocardiographic results at discharge 1-year- and 2-year-follow-up. TVR was combined with mitral valve surgery in 62% vs. 72%, isolated TVR was performed in 32% vs. 23%.
RESULTS: Postoperative echo at discharge showed competent valves without any TR in 83% of patients in group 1, with all other patients with TR≤1, and 75% without any TR in Gr.2, with 19% of patients with TR≤1 and 6% with TR≤2 (p=0.15). At 2 year follow-up mean TR was 0.43±0.65 vs. 0.62±0.92 (p=0.119) with 4% vs. 12% of patients showing recurrent TR≥2 in Gr. 1 vs. Gr.2 (p=0.008). Mean NYHA score after 1year was1.4 ± 0.5 vs.1.7 ± 0.5 (p=0.006) in Gr.1 vs. Gr. 2, and 1.4 ± 0.6 vs.1.9 ± 0.4(p=0.003) after 2 years respectively. In gr.1 RV function improved significantly from preoperative 37% with a moderate dysfunction to 24% after 2 years (p=0.04). In gr. 2 no significant improvement was seen (preoperative: 34%, 2 yrs: 33%).
Concomitant atrial ablation was performed significantly more often in Gr. 2 (60% vs. 37% in Gr.1; p< 0.05), incidence of postoperative permanent pacemaker implantation was not significant different between groups (26% vs. 23%; Gr. 1 vs. 2) nor was overall MACE at 1-and 2-year follow up. Mortality after 2 years was 6% vs. 5%.
CONCLUSIONS: Both tricuspid rings showed excellent repair results at discharge. At 1 year follow-up, patients in the 3D Contour ring group showed less significant recurrent TR, better RV function and lower NYHA scoring.
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