Objective

Untreated severe tricuspid regurgitation (TR) is associated with poor short and long term survival. Several surgical techniques have been proposed to repair severe TR in patients referred for mitral valve surgery. The additional cost of annuloplasty rings are significant while De Vega annuloplasty is more cost effective. We have retrospectively reviewed our experience with both techniques over the past 10 years to determine if one technique achieves better outcomes.

Methods

We retrospectively reviewed the data on 50 patients who underwent concomitant tricuspid valve repair for severe TR from 2006 to 2015 in our unit. 41 patients had Tricuspid ring annuloplasty and 9 had De Vega’s annuloplasty repair. Data on follow-up echocardiographic evaluation of residual TR was obtained through our own imaging database and from all referring Hospitals around Scotland. The degree of postoperative residual TR was quantified as mild, moderate or severe.

Results

82% (n=41) of patients had ring annuloplasty and 18%(n=9) had De Vega’s annuloplasty. The mean age was 66. The interval between the operation and follow-up echocardiogram ranged from immediately post-op to 7 years. In our cohort of patients, there was 1 mortality after De Vega’s annuloplatsy and 1 patient had a re-operation following ring annuloplasty. Of the De Vega annuloplasty group, 11% (n=1) had moderate residual TR and of the ring annuloplasty group, 12% (n=5) had moderate-severe TR.

Conclusion

In our experience, tricuspid valve repair in patients with severe TR requiring mitral valve surgery, offers excellent long-term results in terms of freedom from recurrent severe TR. Tricuspid valve repair using an annuloplasty ring or the DeVega technique may be equally effective and durable. DeVega annuloplasty offers the additional advantage of lower costs.