Outcomes Following Tricuspid Valve Repair with Ring Versus Suture Bicuspidization Annuloplasty

Abstract Background Ring annuloplasty (Ring) and suture bicuspidization annuloplasty (Suture-bicuspidization) are two utilized techniques for tricuspid valve repair. With the emergence of transcatheter tricuspid valve repair technologies that mimic these conventional surgical techniques, we compared their mid-term outcomes and longitudinal echocardiographic profiles. Methods From 2002 to 2016, 650 patients underwent TV repair (324 Ring and 326 Suture-bicuspidization) for primary or functional tricuspid regurgitation (TR). Concomitant aortic valve, mitral valve or CABG procedures were included but tricuspid valve replacement, concomitant aortic procedures, heart transplantation or ventricular assist device placement procedures were excluded. Tricuspid valve event-free survival was estimated using Kaplan-Meier competing risk analysis. Freedom from TR recurrence (defined as at least moderate TR) and freedom from tricuspid valve reoperation were also assessed. Results There were no statistical differences in terms of age, gender, and most baseline comorbidities (P>0.05). In-hospital outcomes also did not significantly differ between the two groups (P>0.05). However, Suture-bicuspidization was associated with significantly lower tricuspid valve event-free survival, and freedom from TR recurrence and tricuspid valve reoperation compared to Ring at 1, 5 and 8 years (all P Conclusions The superiority of Ring over Suture-bicuspidization annuloplasty for tricuspid valve repair appeared to be evident in terms of event-free survival, and freedom from tricuspid valve insufficiency and reoperation. These findings raise concern in the context of emerging transcatheter technologies which mimic the bicuspidization technique.