Medium-term assessment of functional tricuspid regurgitation after annuloplasty using a three-dimensional rigid ring Valoración a medio plazo de la insuficiencia tricuspídea funcional tras anuloplastia con anillo rígido tridimensional

Significant functional tricuspid regurgitation is associated with a high morbidity and mortality if not repaired during left heart-valve surgery, or if it recurs during the follow-up. Classic tricuspid annuloplasty with suture techniques has a high rate of tricuspid regurgitation recurrence. Annuloplasty techniques with prosthetic rings are currently preferred for this condition, since they have longer-lasting results during the follow-up. The objectives of this study are to assess the medium-term echocardiographic outcomes of tricuspid annuloplasty using a three-dimensional rigid ring, and to determinate the predictive factors for recurrence of significant tricuspid regurgitation after annuloplasty. Variables were collected from a total 260 tricuspid annuloplasties with a three-dimensional rigid ring performed in our centre, along with the clinical and echocardiographic follow-up data. A multivariate regression analysis was carried out in order to establish the risk factors predisposing to significant tricuspid regurgitation during the follow-up. After a median follow-up time 16 months (3.9-34.5), 220 patients (84.62%) had a control echocardiogram. Persistent/recurrent severe tricuspid regurgitation occurred in 5.0%. Risk factors for significant tricuspid regurgitation after annuloplasty were: Severe pulmonary hypertension at follow-up (OR 337.91; 95% CI: 34.60-3300.07; P<.001) and post-operative right heart failure (OR 1.02; 95% CI: 1.003-1.037; P=.021). Preserved left ventricle function (OR 0.96; 95% CI: 0.927-0.993; P=.018) and concomitant mitral surgery (OR 0.97; 95% CI: 0.960-0.990; P=.001) emerged as protector factors. Tricuspid annuloplasty using a three-dimensional rigid ring is an effective procedure for correcting secondary tricuspid regurgitation, with a low rate of persistent or recurrent significant tricuspid regurgitation during the followup.