Functional tricuspid regurgitation in rheumatic heart disease: surgical options.

OBJECTIVES In this study, we compare the follow-up results of two types of tricuspid valve repair and review the results of no repair in moderately severe tricuspid regurgitation (TR) along with mitral valve replacement or mitral and aortic valve replacement. PATIENTS AND METHODS This prospective follow-up study, carried out on 106 consecutive patients, was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, from September 1994 through August 2008. The patients were divided into three groups: suture bicuspidization, 36 (34%); modified De Vega's repair, 47 (44.3%); and no repair, 23 (21.7%). Freedom from moderate 2+ TR was compared among these groups by the Kaplan-Meier method. RESULTS In the suture bicuspidization group, freedom from TR2+ was 97.2%, 77.8%, and 39.6% at 30 days and 7 and 14 years after surgery, respectively. In the modified De Vega group, it was 100% at the end of 7 years. In the no-repair group, it was 91.3%, 91.3%, and 61.6% at 30 days and 7 and 14 years after surgery, respectively. Overall in-hospital mortality was 3 (2.8%), with 4 late deaths after discharge. Preoperative right ventricular dysfunction, preoperative TR severity, preoperative mitral regurgitation, preoperative ejection fraction, and remnant TR following surgery were significant independent predictors of TR recurrence. CONCLUSION Repair by suture bicuspidization fails to prevent further annular dilatation and has no comparable results. Modified De Vega's repair is safe with superior results compared to other groups at the end of 7 years. Patients without significant annular dilatation in the no-repair group improved during follow-up once their left-sided valve lesion was corrected.