European Journal of Cardiovascular Medicine

Background: Tricuspid valve repair for moderate to severe functional tricuspid regurgitation is effectively performed as a concomitant procedure during mitral valve surgery. Although various studies have shown that three dimensional rigid rings are gold standard for tricuspid valve annuloplasty, fashioned prosthetic bands are also used. Our study is aimed to compare the results of using a rigid ring versus prosthetic fashioned band (teflon strip) for functional tricuspid regurgitation in patients undergoing mitral valve surgery. Methods: A single-centre randomized study was designed to allocate patients with functional tricuspid regurgitation undergoing mitral valve surgery to be treated with either a rigid ring or a prosthetic fashioned band (PTFE). A prospective randomized study was done for a period of three years between January 2018 to December 2021 at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru. 188 patients were enrolled in this study. Inclusion criteria: all patients with moderate or more TR secondary to severe mitral regurgitation or stenosis. Exclusion criteria: Patients with mild TR, with no annular dilatation or severe pulmonary hypertension; patients with organic TR, patients with concomitant coronary artery disease and those with isolated TR. The primary outcome was freedom from progression of TR by more than 2 grades at 12-months follow-up in both the groups. Results: The data of 188 adult patients with moderate or more functional tricuspid regurgitation secondary to mitral stenosis or regurgitation receiving tricuspid valve repair using either rigid rings or prosthetic fashioned bands (Teflon) and mitral valve surgery. Patients were classified into two matched groups: rigid ring group (group A) consisting of 96 cases and prosthetic teflon band group (group B) consisting of 92 cases. In-hospital mortality was similar among both the groups. Rigid ring and Teflon strip annuloplasty improved postoperative tricuspid regurgitation grades, systolic pulmonary artery pressure and TAPSE (tricuspid annular plane systolic excursion) as compared to baseline values. Conclusion: Tricuspid valve repair with rigid rings or fashioned flexible bands must be used for moderate or more secondary TR while addressing the mitral valve to prevent further progression of TR grades and eventual right ventricular dysfunction. Our study showed that both rigid rings and flexible bands offer good long-term outcomes in terms of preventing progression of TR, preventing right ventricular dysfunction and providing freedom from re-operations.