Technique and Interim Outcomes of Surgical Tricuspid Valve Repair Modalities in Adults: A Prospective Randomized Clinical Study

Abstract Background: Tricuspid regurgitation (TR), which is hemo-dynamically significant, can cause severe symptoms and has a poor prognosis, especially in patients who also have concurrent left sided valvular pathology. Aim of Study: This research endeavored to study the feasi-bility and short-term results of different surgical techniques in the repair of tricuspid valve regurgitation in adults. Patients and Methods: This single center, prospective, multi-arm, parallel, randomized, controlled, triple blinded, study was conducted for all patients operated for Tricuspid valve regurgitation in scope of concomitant mitral valve re-placement at our university hospital during the study period. Patients were randomly stratified into 3 equal groups: Group A (De-Vega Annuloplasty, n=25), Group B (Segmental Annu-loplasty, n=25), and Group C (other valvuloplasty techniques; Kays’s repair n=8, pericardial strip annuloplasty n=8 and ring annuloplasty n=9). All cases were assessed pre-operatively and post-operatively at 2 weeks, 3 months and 6 months. Results: Included were 75 patients (64% females) with a mean age of 46.86±7.3 years. Two cases (8%) in group A required repetition of the repair due to suboptimal result (p=0.018) while 1 case (4%) with pericardial strip annuloplasty repair was repeated due to moderate TR upon TEE. Replacement with porcine prosthesis following a failed re-pair was done in one case (4%) in group A and One case (4%) in group C who underwent a pericardial strip annuloplasty. There was no statistical difference as regards the mechani-cal ventilation times in hours while the length of ICU stay was significantly longer in group B (d.f=2, F=4.54, p=0.014). There was a significant improvement of the NYHA class among the operated patients. Group B has the most significant improvement of the NYHA class as compared to the other groups. There was no statistically significant difference as re-gards mortality. There was a statistically significant improvement of the LV and RV function as well as reduction of left atrial and left ven-tricular dimension among the studied groups. The RVSP has a significant drop among the groups and duration of follow-up. Logistic regression analysis was used to identify positive predictors of repair failure were Tricuspid annular diameter >40mm in cases without ring annuloplasty (0.042), severe preoperative TR (p<0.001), and pre-operative heart failure (p=0.037).