Adjustable segmental annuloplasty in the correction of functional failure of the tricuspid valve on beating heart

Abstract

The research purpose. The comparison of the results of TV functional failure correction by the method of adjustable segmental annuloplasty and implantation of the support ring Carpentier, and the identification ofpredictors of relapse of tricuspid failure after surgery.Methods. 331 patients (163 men and 168 women) were included in the research and were operated from 2008 to 2012 in FCCS `Federal Center of Cardiovascular Surgery of the Ministry of Health of Russia` in Penza. The average age of the patients was 61,1±9,6 years (from 32 to 79 years). The correction of functional failure of TV was made to all the patients as a part of the main surgery. The patients were divided into 2 groups: the first group includes 250 (75%) patients who were completed adjustable seam annuloplasty; the second group had 81 (26%) patients, who were implanted the support ring Carpentier in the tricuspid position. All the patients had the significant failure on TV, whose average value was more than 3+. All the patients had dilation of the fibrous ring of TV, which average diameter was 43±3,2mm. 181 (55%) patients were examined in the post period from 2 to 60 months, on average 39,6 ± 5,7 months. The degree of regurgitation on TV in the pre and postoperative period was evaluated by the method of echocardiography. The regurgitation on TV 2+ and more was considered significant. The survival and the development of recurrent regurgitation were evaluated by the method of Kaplan- Meier.Results. The reliably significant differences in mortality (p=0,7) and complications in the early postoperative period (p=0,34) in groups weren`t identified. The freedom from regurgitation on TV more than 2+ was 71±1,2% in the 1st group and 75±1,2 % in the 2d group (p=0,4) in the long-term periods of observation. Reoperation was not required in any of the cases. The survival period of up to 5 years was 92±1,2% in the 1st group and 91±1,3% in the 2dt group (p=0,7).Conclusions. Adjustable segmental annuloplasty in the correction of functional failure of the tricuspid valve is not inferior to other kinds of plastic on the degree of the freedom from regurgitation and survival, allowing to save the competence of TV in the period up to 5 years among more than 70% of patients. The efficiency of the method in the long-term period does not depend on the majority of risk factors of progress of relapse failure which were before the operation. Keywords: annuloplasty, tricuspid valve