Maximal Beneficials Foreshows of Adopting De Vega Annuloplasy Technique Addressing Secondary Severe Tricuspid Regurgitation

Abstract Background: Persistence of significant secondary tricuspid regurgitation (TR) after its repair concomitant with a left-sided valve replacement contributes to increased mortality and morbidity in the immediate and late postoperative periods. Thus, attention is paid to trace risk factors that might affect the success of the repair. However, the knowledge of the exact underlying risk factors and relevant mechanisms contributing to progression of secondary TR is less. Aim of Study: This study aims at identifying the effective-ness of adopting De Vega annuloplasty technique in dealing with cases of secondary severe TR in decreasing or abolishing it (over one year follow-up period) and evaluating the possible risk factors of failure of repair as well. As such, the purpose of addressing agents favoring the best accepted results of the nominated maneuver and planning the optimal surgical method of such secondary TR could be achieved. Patients and Methods: This retrospective observational non-randomized study included 31 patients who had repair of the tricuspid valve (TV) by De Vega annuloplasty technique. They presented with either mitral valve disease and associated secondary severe TR (double valve disease) or combined mitral and aortic valves disease and associated secondary severe TR (triple valve disease). They had been operated upon be either mitral valve replacement (MVR) and De Vega annuloplasty for the TV or combined MVR and aortic valve replacement (AVR) i.e., double valve replacement (DVR) and De Vega annuloplasty for the TV. Postoperative mortality, morbidity outcomes, overall hospital complications, left ventricular ejection fraction (LVEF%), TR degree, functional clinical status, predictorsof failure of TV repair and overall one-year survival were evaluated. Results: Mean age was 37.25±7.31 years. The overall hospital complication rate was 25.80%. No mortality happened during the follow-up period (overall one-year survival rate was 100%). The cumulative duration of the study was 3.167 years. Significant improvement in the degree of TR, New Yok Heart Association (NYHA) classification and LVEF% was observed. Identified risk factors that were found to be statis-tically significant predictors of progression of the secondary TR after surgery by multivariable analysis were preoperative heart failure [OR: 14.245 (95% CI: 2.658-93.352); p= 0.002], prolonged period from onset of diagnosis to surgery [OR: 11.213 (95% CI: 2.234-86.584); p=0.006], atrial fibrillation (AF) [OR: 2.33 (95% CI: 1.088-5.068); p=0.018], enlarged left atrial diameter (LAD) [OR: 2.011 (95% CI: 0.981-9.375); p= 0.049] and dilated right ventricle (RV) [OR: 1.561 (95% CI: 1.115-2.389]; p<0.001). Conclusion: Repair of the secondary TR at the setting of left-sided valve surgery is critical in achieving better results of preserving LVEF%, NYHA maneuver in dealing with severe secondary TR. Predictors of progression of secondary TR and failure of repair include preoperative heart failure, prolonged period from onset of diagnosis to surgery, AF, enlarged LAD and dilated RV. Preoperative assessment of these risk factors is crucial in decision-making and determining the best surgical option. We recommend applying De Vega annuloplasty in patients with any of these risk factors in their preoperative profile.