Modified Annuloplasty of the Tricuspid Valve: Technique and Long-Term Results

Abstract

Acquired tricuspid insufficiency (TI) is mostly seen in patients with concomitant mitral valve disease. Today our indication for tricuspid annuloplasty (TAP) is extended to all cases with preoperatively confirmed TI. We have adopted the technique of the De Vega annuloplasty. However, we had some problems with the adequate constriction of the anulus which led to a simple modification. We now use two parallel stitched sutures secured by a pledget from both sides of the septal leaflet to the anterior valve ring where both sutures are knotted after differentiated constriction of the anulus in close relation to the extended parts of the valve ring. Intraoperative control of the tricuspid valve function with the beating heart can be easily performed. We reviewed 105 patients who all had TI and considerable rheumatic mitral valve disease (stenosis, n = 39; combined, n = 62; insufficiency, n = 4). The preoperative cineangiographic investigations demonstrated the following results: grade 0, no patients, grade 1, 29 patients (27.6%); grade 2, 56 patients (53.3%); grade 3, 20 patients (19.1%). The postoperative TI results were as follows: grade 0, 22 patients (21%); grade 1, 58 patients (55.2%); grade 2, 25 patients (23.8%); grade 3, no patients. These data clearly demonstrate the effectiveness of our modified technique of TAP.