Echocardiographic approach to the decision-making process for tricuspid valve repair

Objective: Commonly used procedures to repair functional tricuspid regurgitation have a high failure rate. The present study was designed to lower this failure rate by reducing leaflet tethering via pericardial patch augmentation when the preoperative probability of recurrence was high. Methods: Between 2001 and 2007, 210 patients with severe functional tricuspid regurgitation underwent tricuspid valve repair at the Day General Hospital. With respect to the type of repair, the patients were randomly divided into 4 groups: (1) De Vega in 52 patients; (2) ring annuloplasty in 53 patients; (3) De Vega and, if indicated by the preoperative tethering index (tethering distance > 8 mm or tethering area > 16 mm(2)), pericardial patch augmentation in 53 patients; and (4) ring annuloplasty and, if indicated by the preoperative tethering index (tethering distance > 8 mm or tethering area > 16 mm(2)), pericardial patch augmentation in 52 patients. The results of 1-month and 1-year postoperative tricuspid regurgitation were evaluated. Results: Fifteen patients in group 3 and 15 patients in group 4 met the criterion for the complementary procedure. Postoperative tricuspid regurgitation was different between the groups (P < .05): 16.0% and 28.0% of patients in the De Vega group, 8.0% and 14.0% of patients in the ring annuloplasty group, 4.0% and 10.0% of patients in the De Vega+pericardial patch augmentation group, and 2.0% and 8.0% of patients in the ring annuloplasty+pericardial patch augmentation group had postoperative tricuspid regurgitation at 1-month and 1-year follow-up, respectively. Conclusion: An assessment of preoperative tricuspid valve tethering to select patients suitable for augmentation contributes to a good surgical outcome in patients with severe functional tricuspid regurgitation. (J Thorac Cardiovasc Surg 2010;139:1483-7)