Outcomes After Tricuspid Valve Repair With Ring Versus Suture Bicuspidization Annuloplasty

Ann Thorac Surg. 2020 Sep;110(3):821-828. doi: 10.1016/j.athoracsur.2019.12.023. Epub 2020 Jan 28.


Background: Ring annuloplasty (Ring) and suture bicuspidization annuloplasty (Suture-bicuspidization) are 2 techniques for tricuspid valve repair. With the emergence of transcatheter tricuspid valve repair technologies that mimic these conventional surgical techniques, we compared their midterm outcomes and longitudinal echocardiographic profiles.

Methods: From 2002 to 2016, 650 patients underwent tricuspid valve repair (324 Ring and 326 Suture-bicuspidization) for primary or functional tricuspid regurgitation (TR). Concomitant aortic valve, mitral valve, or coronary artery bypass graft procedures were included but tricuspid valve replacement, concomitant aortic procedures, heart transplantation or ventricular assist device placement procedures were excluded. Tricuspid valve event-free survival was estimated using Kaplan-Meier competing risk analysis. Freedom from TR recurrence (defined as at least moderate TR) and freedom from tricuspid valve reoperation were also assessed.

Results: There were no statistical differences in terms of age, gender, and most baseline comorbidities (P > .05). In-hospital outcomes also did not significantly differ between groups (P > .05). However, Suture-bicuspidization was associated with significantly lower tricuspid valve event-free survival, and freedom from TR recurrence and tricuspid valve reoperation compared with Ring at 1, 5, and 8 years (all P < .05). After adjusting for significant confounders, Suture-bicuspidization continued to be associated with significantly decreased tricuspid valve event-free survival (hazard ratio = 2.13; 95% confidence interval, 1.3-3.4).

Conclusions: The superiority of Ring over Suture-bicuspidization annuloplasty for tricuspid valve repair appeared to be evident in terms of event-free survival and freedom from tricuspid valve insufficiency and reoperation. These findings raise concern in the context of emerging transcatheter technologies that mimic the bicuspidization technique.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiac Valve Annuloplasty*
  • Echocardiography
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Suture Techniques*
  • Treatment Outcome
  • Tricuspid Valve Insufficiency / diagnosis
  • Tricuspid Valve Insufficiency / mortality
  • Tricuspid Valve Insufficiency / surgery*