Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes

Background - The purpose of this study was to compare the long-term results of tricuspid valve (TV) repair with or without an annuloplasty ring. Methods and Results - 702 patients underwent TV repair at our institution (1978 to 2003), of which 493 had, predominantly, a De Vega procedure (no ring) and 209 had an annuloplasty ring (ring). TV pathology was functional (secondary) in 74% of patients. Concomitant procedures consisted of mitral valve surgery in 80% of patients, aortic valve surgery in 33%, and coronary bypass in 14%. Clinical and echocardiographic follow-up data were obtained. Follow- up was 99% complete and was 5.9 +/- 4.9 ( mean +/- SD) years long. Ring patients were younger (55 +/- 14 versus 59 +/- 14 years; P = 0.001) and less likely to have coronary artery disease (10% versus 17%; P = 0.02), more likely to be female (75% versus 65%; P = 0.01) and having had previous cardiac surgery ( 56% versus 42%; P = 0.001). Operative times were similar between the 2 groups. Long-term survival, event-free survival and freedom from recurrent TR were significantly better in the ring group, and there was a trend toward fewer TV reoperations. Multivariable analysis demonstrated that the use of an annuloplasty ring was an independent predictor of long-term survival (hazard ratio [HR], 0.7; 95% confidence interval [CI], 0.5 to 1.0; P = 0.03) and event- free survival (HR, 0.8; CI, 0.6 to 1.0; P = 0.04). Conclusions - Placement of an annuloplasty ring in patients undergoing tricuspid valve repair is associated with improved survival and event- free survival.