J Korean Med Sci.  2013 Dec;28(12):1756-1761. 10.3346/jkms.2013.28.12.1756.

De Vega Annuloplasty for Functional Tricupsid Regurgitation: Concept of Tricuspid Valve Orifice Index to Optimize Tricuspid Valve Annular Reduction

• Hwang HY
• Chang HW
• Jeong DS
• Ahn H

• KMID: 1779416
• DOI: http://doi.org/10.3346/jkms.2013.28.12.1756

Abstract

We evaluated long-term results of De Vega annuloplasty measured by cylindrical sizers for functional tricuspid regurgitation (FTR) and analyzed the impact of measured annular size on the late recurrence of tricuspid valve regurgitation. Between 2001 and 2011, 177 patients (57.9+/-10.5 yr) underwent De Vega annuloplasty for FTR. Three cylindrical sizers (actual diameters of 29.5, 31.5, and 33.5 mm) were used to reproducibly reduce the tricuspid annulus. Long-term outcomes were evaluated and risk factor analyses for the recurrence of FTR > or =3+ were performed. Measured annular diameter indexed by patient's body surface area was included in the analyses as a possible risk factor. Operative mortality occurred in 8 patients (4.5%). Ten-year overall and cardiac death-free survivals were 80.5% and 90.8%, respectively. Five and 10-yr freedom rates from recurrent FTR were 96.5% and 93.1%, respectively. Cox proportional hazard model revealed that higher indexed annular size was the only risk factor for the recurrence of FTR (P=0.006). A minimal P value approach demonstrated that indexed annular diameter of 22.5 mm/m2 was a cut-off value predicting the recurrence of FTR. De Vega annuloplasty for FTR results in low rates of recurrent FTR in the long-term. Tricuspid annulus should be reduced appropriately considering patients' body size to prevent recurrent FTR.

Keyword

Tricuspid Valve insufficiency; Cardiac Valve Annuloplasty

MeSH Terms

Adult
Age Factors
Aged
Body Surface Area
Cardiac Valve Annuloplasty
Disease-Free Survival
Echocardiography
Female
Humans
Hypertension/complications
Male
Middle Aged
Postoperative Complications
Proportional Hazards Models
Recurrence
Risk Factors
Treatment Outcome
Tricuspid Valve/*physiopathology
Tricuspid Valve Insufficiency/etiology/mortality/*surgery

Figure

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  Fig. 1 Early postoperative changes in grades of tricuspid regurgitation.

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  Fig. 2 A Kaplan-Meier curve for freedom from tricuspid regurgitation (TR) ≥ 3+.

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  Fig. 3 A Kaplan-Meier curve for freedom from tricuspid regurgitation (TR) ≥3+ according to the cut-off value of tricuspid valve orifice index (TVOI).

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