Outcomes of ring versus suture annuloplasty for tricuspid valve repair in patients undergoing mitral valve surgery

Sung Ho Shinn, Victor Dayan, Hartzell V Schaff, Joseph A. Dearani, Lyle D. Joyce, Brian Lahr, Kevin L. Greason, John M. Stulak, Richard C. Daly

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective There is controversy regarding the comparative effectiveness of methods of tricuspid valve (TV) repair—prosthetic ring versus suture annuloplasty—in patients undergoing operation for primary mitral valve (MV) disease. In this study, we analyzed factors associated with patient survival and recurrent tricuspid regurgitation (TR) following TV repair and focused on results stratified by method of tricuspid valve repair. Methods We reviewed patients who underwent TV repair with suture (De Vega) or flexible ring annuloplasties at the time of MV surgery from 1995 to 2010. Patients with prior cardiac or concomitant aortic valve operations were excluded. Propensity matching was performed to account for potential differences in baseline characteristics between the groups. Primary outcomes were long-term mortality and postoperative TR grade. Results In the overall study, there were 415 patients with median age 72 years (range, 63-78 years), from which 148 matched pairs were identified by propensity score analysis. In the overall cohort, patients in the ring annuloplasty group more often had preoperative transvenous pacemakers (P = .05), lower ejection fractions (P = .028), and more recent years of operation (P < .001). For patients who had De Vega suture annuloplasty, long-term mortality was not different from that of patients who had ring annuloplasty (hazard ratio, 0.93; 95% confidence interval, 0.67-1.30). Older age, preoperative diabetes, and preoperative right ventricular dysfunction were predictors for long-term mortality. Durability of the annuloplasty methods was similar with no significant difference in trend of recurrent TR grades over follow-up (P = .807). Etiology of mitral regurgitation was not associated with recurrent TR during follow-up (P = .857). Conclusions Late survival and TV durability following concomitant TV repair during MV surgery did not differ with respect to TV repair technique. In this series of patients with repaired tricuspid valves, etiology of MV disease did not influence postoperative changes in TR.

Original languageEnglish (US)
Pages (from-to)406-415.e3
JournalJournal of Thoracic and Cardiovascular Surgery
Volume152
Issue number2
DOIs
StatePublished - Aug 1 2016

Fingerprint

Tricuspid Valve
Mitral Valve
Sutures
Tricuspid Valve Insufficiency
Mortality
Right Ventricular Dysfunction
Propensity Score
Survival
Mitral Valve Insufficiency
Aortic Valve
Confidence Intervals

Keywords

  • tricuspid valve regurgitation
  • tricuspid valve repair

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of ring versus suture annuloplasty for tricuspid valve repair in patients undergoing mitral valve surgery. / Shinn, Sung Ho; Dayan, Victor; Schaff, Hartzell V; Dearani, Joseph A.; Joyce, Lyle D.; Lahr, Brian; Greason, Kevin L.; Stulak, John M.; Daly, Richard C.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 152, No. 2, 01.08.2016, p. 406-415.e3.

Research output: Contribution to journalArticle

Shinn, Sung Ho ; Dayan, Victor ; Schaff, Hartzell V ; Dearani, Joseph A. ; Joyce, Lyle D. ; Lahr, Brian ; Greason, Kevin L. ; Stulak, John M. ; Daly, Richard C. / Outcomes of ring versus suture annuloplasty for tricuspid valve repair in patients undergoing mitral valve surgery. In: Journal of Thoracic and Cardiovascular Surgery. 2016 ; Vol. 152, No. 2. pp. 406-415.e3.
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abstract = "Objective There is controversy regarding the comparative effectiveness of methods of tricuspid valve (TV) repair—prosthetic ring versus suture annuloplasty—in patients undergoing operation for primary mitral valve (MV) disease. In this study, we analyzed factors associated with patient survival and recurrent tricuspid regurgitation (TR) following TV repair and focused on results stratified by method of tricuspid valve repair. Methods We reviewed patients who underwent TV repair with suture (De Vega) or flexible ring annuloplasties at the time of MV surgery from 1995 to 2010. Patients with prior cardiac or concomitant aortic valve operations were excluded. Propensity matching was performed to account for potential differences in baseline characteristics between the groups. Primary outcomes were long-term mortality and postoperative TR grade. Results In the overall study, there were 415 patients with median age 72 years (range, 63-78 years), from which 148 matched pairs were identified by propensity score analysis. In the overall cohort, patients in the ring annuloplasty group more often had preoperative transvenous pacemakers (P = .05), lower ejection fractions (P = .028), and more recent years of operation (P < .001). For patients who had De Vega suture annuloplasty, long-term mortality was not different from that of patients who had ring annuloplasty (hazard ratio, 0.93; 95{\%} confidence interval, 0.67-1.30). Older age, preoperative diabetes, and preoperative right ventricular dysfunction were predictors for long-term mortality. Durability of the annuloplasty methods was similar with no significant difference in trend of recurrent TR grades over follow-up (P = .807). Etiology of mitral regurgitation was not associated with recurrent TR during follow-up (P = .857). Conclusions Late survival and TV durability following concomitant TV repair during MV surgery did not differ with respect to TV repair technique. In this series of patients with repaired tricuspid valves, etiology of MV disease did not influence postoperative changes in TR.",
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T1 - Outcomes of ring versus suture annuloplasty for tricuspid valve repair in patients undergoing mitral valve surgery

AU - Shinn, Sung Ho

AU - Dayan, Victor

AU - Schaff, Hartzell V

AU - Dearani, Joseph A.

AU - Joyce, Lyle D.

AU - Lahr, Brian

AU - Greason, Kevin L.

AU - Stulak, John M.

AU - Daly, Richard C.

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N2 - Objective There is controversy regarding the comparative effectiveness of methods of tricuspid valve (TV) repair—prosthetic ring versus suture annuloplasty—in patients undergoing operation for primary mitral valve (MV) disease. In this study, we analyzed factors associated with patient survival and recurrent tricuspid regurgitation (TR) following TV repair and focused on results stratified by method of tricuspid valve repair. Methods We reviewed patients who underwent TV repair with suture (De Vega) or flexible ring annuloplasties at the time of MV surgery from 1995 to 2010. Patients with prior cardiac or concomitant aortic valve operations were excluded. Propensity matching was performed to account for potential differences in baseline characteristics between the groups. Primary outcomes were long-term mortality and postoperative TR grade. Results In the overall study, there were 415 patients with median age 72 years (range, 63-78 years), from which 148 matched pairs were identified by propensity score analysis. In the overall cohort, patients in the ring annuloplasty group more often had preoperative transvenous pacemakers (P = .05), lower ejection fractions (P = .028), and more recent years of operation (P < .001). For patients who had De Vega suture annuloplasty, long-term mortality was not different from that of patients who had ring annuloplasty (hazard ratio, 0.93; 95% confidence interval, 0.67-1.30). Older age, preoperative diabetes, and preoperative right ventricular dysfunction were predictors for long-term mortality. Durability of the annuloplasty methods was similar with no significant difference in trend of recurrent TR grades over follow-up (P = .807). Etiology of mitral regurgitation was not associated with recurrent TR during follow-up (P = .857). Conclusions Late survival and TV durability following concomitant TV repair during MV surgery did not differ with respect to TV repair technique. In this series of patients with repaired tricuspid valves, etiology of MV disease did not influence postoperative changes in TR.

AB - Objective There is controversy regarding the comparative effectiveness of methods of tricuspid valve (TV) repair—prosthetic ring versus suture annuloplasty—in patients undergoing operation for primary mitral valve (MV) disease. In this study, we analyzed factors associated with patient survival and recurrent tricuspid regurgitation (TR) following TV repair and focused on results stratified by method of tricuspid valve repair. Methods We reviewed patients who underwent TV repair with suture (De Vega) or flexible ring annuloplasties at the time of MV surgery from 1995 to 2010. Patients with prior cardiac or concomitant aortic valve operations were excluded. Propensity matching was performed to account for potential differences in baseline characteristics between the groups. Primary outcomes were long-term mortality and postoperative TR grade. Results In the overall study, there were 415 patients with median age 72 years (range, 63-78 years), from which 148 matched pairs were identified by propensity score analysis. In the overall cohort, patients in the ring annuloplasty group more often had preoperative transvenous pacemakers (P = .05), lower ejection fractions (P = .028), and more recent years of operation (P < .001). For patients who had De Vega suture annuloplasty, long-term mortality was not different from that of patients who had ring annuloplasty (hazard ratio, 0.93; 95% confidence interval, 0.67-1.30). Older age, preoperative diabetes, and preoperative right ventricular dysfunction were predictors for long-term mortality. Durability of the annuloplasty methods was similar with no significant difference in trend of recurrent TR grades over follow-up (P = .807). Etiology of mitral regurgitation was not associated with recurrent TR during follow-up (P = .857). Conclusions Late survival and TV durability following concomitant TV repair during MV surgery did not differ with respect to TV repair technique. In this series of patients with repaired tricuspid valves, etiology of MV disease did not influence postoperative changes in TR.

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