Outcome of MC3 Ring Annuloplasty for Functional Tricuspid Regurgitation
Outcome of MC3 Ring Annuloplasty for Functional Tricuspid Regurgitation
This study includes 105 patients who underwent repair for ≥ moderate tricuspid regurgitation
 (TR) during mitral valve replacement for rheumatic valve disease. Between January 2016 and
 December 2018, a group of 23 patients underwent ring annuloplasty with Edward MC3 rings were
 compared to another group of 82 patients underwent standard suture (DeVega) repair. The
 primary outcome was residual TR (≥ moderate TR).
This study evaluated early and midterm outcomes after operations for TV repair which were
 performed at our institution, between January 2016 and December 2018. The mean follow-up
 duration was 18.84±9.90 months (range: 3-33 months). The study included 105 patients who
 underwent repair for FTR during mitral valve replacement for rheumatic valve disease. There
 were 82 patients underwent suture (DeVega) repair and 23 patients underwent ring annuloplasty
 using Edward MC3 incomplete 3D ring. The indications of surgery for FTR were: (1) severe TR;
 or (2) moderate TR with annular dilatation greater than 40 mm and/or preoperative systolic
 pulmonary artery pressure (SPAP) >50 mmHg. We excluded patients with non-rheumatic mitral
 disease, combined mitral and aortic valve replacement, mitral valve repair, concomitant
 coronary artery or aortic surgery, mild or organic tricuspid regurgitation, emergency
 surgery, reoperations or missed data. Based on echocardiographic data, the severity of TR was
 graded as: 0 (no TR), 1+ (mild TR), 2+ (mild to moderate TR), 3+ (moderately severe TR), or
 4+ (severe).

 The type of tricuspid valve repair was chosen in according to surgeon's preference and
 echocardiographic criteria of TV. The DeVega repair was performed when the patient had
 minimal annular dilation and lower severity of pulmonary hypertension, while ring
 annuloplasty was performed in patients with severe tricuspid annular dilation and severe
 pulmonary hypertension. The DeVega repair was performed on a beating heart using
 pledget-supported two 4-0 polypropylene running parallel sutures. The MC3 ring annuloplasty
 was performed through right atriotomy using cardiopulmonary bypass and cardioplegic arrest.
 The ring size was determined after measurement of the length of the attachments of the
 tricuspid septal leaflet (the distance between the anteroseptal and septoposterior
 commissures) or the surface area of the anterior leaflet. The chosen ring was undersized by
 at least one size. The ring was implanted from the anteroseptal commissure to the middle of
 the septal leaflet. A series of 8 to10 mattress sutures with a 2-0 Ethibond multifilament
 suture were made on the tricuspid annulus starting from the center of the septal annulus to
 the anteroseptal commissure in the counter-clockwise direction, to avoid the atrioventricular
 conduction tissue. Thereafter, the sutures were placed through the sewing ring of the
 prosthesis , followed by lowering and securing of the ring to the annulus The collected
 pre-operative data included age, sex, New York Heart Association (NYHA) functional class, ,
 and the type of preoperative mitral valve disease. The primarily assessed post-operative
 outcome was residual TR (≥ moderate TR; ≥ grade +2). Other assessed pre- and post-operative
 parameters included NYHA functional class, and echocardiographic data regarding grade of TR,
 SPAP, tricuspid annulus (TA) diameter, tricuspid annular plane systolic excursion (TAPSE),
 left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), left
 ventricular end-systolic dimension (LVESD), and left ventricular ejection fraction (LVEF).
Inclusion Criteria:

 -  Rheumatic mitral valve disease

 -  Surgery for mitral valve replacement

 -  Severe functional tricuspid regurgitation

 -  Moderate functional tricuspid regurgitation with annular dilatation > 40 mm

 -  Moderate functional tricuspid regurgitation with preoperative systolic pulmonary
 artery pressure (SPAP) >50 mmHg

 Exclusion Criteria:

 -  Patients with non-rheumatic mitral disease

 -  Combined mitral and aortic valve replacement

 -  Mitral valve repair

 -  Concomitant coronary artery or aortic surgery

 -  Mild or organic tricuspid regurgitation

 -  Emergency surgery

 -  Reoperations

 -  Invalid or missed data