Surgical Treatment of Tricuspid Regurgitation in Combined Valvular Disease

Abstract

Ninety-nine patients were operated upon for tricuspid regurgitation (TR) in combined valvular disease. According to surgical procedures for the tricuspid valve, two groups resulted in "repaired" and "ignored," including 60 patients in the former group and 39 in the latter. There is no significant difference be tween the two groups in the preoperative data, except right atrial pressure (P < 0.04). The repaired group included insertion of 41 Carpentier rings, 11 De Vega annuloplasties, 2 Kay's annuloplasties, and 6 tricuspid valve replacements. Early and late mortalities in the repaired group were 6.7% and 8.3%, respec tively. In the ignored group, they were 5.1% and 7.7%, respectively. Long-term postoperative assessments (mean of forty-nine months) were done in 28 patients in the repaired group and in 21 patients of the ignored group. Residual TR developed in more than 50% of the repaired group patients, in whom tricuspid annuloplasty (TAP) was performed with the insertion of a Carpentier ring. On the other hand, residual TR was present in 33.3% of the ignored group patients. The authors presently recommend TAP by the De Vega's method in patients with mild or moderate TR and tricuspid valve replacement in patients with severe TR. Progressive heart failure secondary to TR developed in several pa tients of the ignored group. This consideration has prompted a more aggressive approach to the management of TR in combined valvular disease.