Mid-term outcomes in patients undergoing tricuspid valve repair with rheumatic tricuspid valve disease

Objective The aim of this study was to summarize the characteristics of rheumatic tricuspid valve disease(RTVD) and to evaluate the mid-term outcomes in patients undergoing tricuspid valve repair with RTVD. Methods Between January 2009 and June 2016, 251 consecutive patients with rheumatic heart disease(RHD) underwent left-sided valvular replacement by a single surgeon. We analyzed 39 patients with RTVD which was diagnosed during the operation. Among them, 32 patients, with moderate or higher tricuspid regurgitation(TR), were compared with other 59 patients of functional tricuspid regurgitation(FTR) for a better understanding of the features of the RTVD. A total of 39 patients were categorized into 2 groups: Ring annuloplasty group(n=33) and non-Ring annuloplasty group(n=6) which consisted of modified De Vega annuloplasty for 4 patients and edge-to-edge repair for 2. Meanwhile, 13 of them underwent concomitant tricuspid commissurotomy and 1 patient had a tricuspid leaflet augmentation procedure. We analyzed the mid-term outcomes of 22 patients(follow-up duration>1 year)with a mean follow-up duration of(45.5±25.1) months. Results Compared with FTR, patients with RTVD had higher preoperative TR grade(3.1±0.8 vs. 2.6±0.7, P=0.004) but with lower preoperative PASP[(53.8±19.4)mmHg vs.(63.6±21.5)mmHg, P=0.037)](1 mmHg=0.133 kPa) and tricuspid annulus diameter(TAD) that observed both in preoperative echocardiogram tests[(37.0±5.7)mm vs.(41.9±6.7 )mm, P=0.018)] and intraoperative detection[(35.6±4.1)mm vs.(39.9±6.5)mm, P=0.000)] . There was no early mortality and residual moderate or higher TR grades in either group. Compared with patients in non-ring annuloplasty group, patients in ring annuloplasty group showed lower postoperative TR grade(0.2±0.4 vs. 0.7±0.5, P=0.039) and acceptable TR grade(0.8±0.5 vs. 1.3±1.9, P>0.050) during the mid-term follow-up. PASP, the peak diastolic velocity and pressure gradient across tricuspid valve were not different between groups in preoperative, postoperative and follow-up. Conclusion Compared with FTR, Patients with RTVD had lower preoperative PASP and TAD, but with a higher preoperative TR grade. In our study, ring annuloplasty showed similar mid-term outcomes compared with other procedures. Key words: Rheumatic tricuspid valve disease; Organic tricuspid valve disease; Tricuspid valve stenosis; Tricuspid valve insufficiency