Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation: midterm results of 237 consecutive patients

J Thorac Cardiovasc Surg. 2007 Jan;133(1):117-26. doi: 10.1016/j.jtcvs.2006.08.068. Epub 2006 Dec 4.


Objective: Uncorrected functional tricuspid regurgitation has serious long-term morbidity and mortality. We reviewed our experience with tricuspid posterior annular bicuspidization versus ring tricuspid annuloplasty for treatment of functional tricuspid regurgitation.

Methods: From 1999 to 2003, 237 patients underwent tricuspid annuloplasty for functional tricuspid regurgitation as part of their cardiac surgical procedure. Bicuspidization was performed in 157 patients and ring annuloplasty in 80 patients. Preoperatively, 227 (96%) patients had moderate or greater tricuspid regurgitation with a median regurgitation of 3+. Follow-up information was obtained for 234 (99%) patients with a mean follow-up time of 3 years. Postoperative transthoracic echocardiograms were assessed for severity of tricuspid regurgitation. Moderate or greater tricuspid regurgitation was considered significant. Survival and development of recurrent tricuspid regurgitation were evaluated by Kaplan-Meier analysis. Tricuspid regurgitation and risk factors for recurrent regurgitation were identified and analyzed by multivariable ordinal longitudinal methods.

Results: At 3 years postoperatively, tricuspid regurgitation in patients treated by bicuspidization annuloplasty was zero to mild in 75%, moderate in 11%, moderate to severe in 6%, and severe in 8% of patients. In those undergoing ring annuloplasty, tricuspid regurgitation was zero to mild in 69%, moderate in 14%, moderate to severe in 7%, and severe in 10%. There was no significant difference between the two groups (P = .18). Risk factors for recurrent tricuspid regurgitation included higher preoperative regurgitation grade, preoperative tricuspid regurgitation without concomitant mitral regurgitation, and higher pulmonary artery systolic pressure.

Conclusions: Bicuspidization annuloplasty and ring annuloplasty were effective at eliminating tricuspid regurgitation at 3 years postoperatively. Bicuspidization annuloplasty is a simple, inexpensive option for addressing functional tricuspid regurgitation. All patients with moderate-to-severe functional tricuspid regurgitation should undergo tricuspid annuloplasty regardless of the technique used.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiac Surgical Procedures / methods
  • Cardiac Surgical Procedures / mortality
  • Echocardiography, Transesophageal
  • Female
  • Heart Valve Prosthesis Implantation
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Recurrence
  • Reoperation
  • Survival Rate
  • Sutures
  • Tricuspid Valve / surgery*
  • Tricuspid Valve Insufficiency / mortality
  • Tricuspid Valve Insufficiency / physiopathology
  • Tricuspid Valve Insufficiency / surgery*