Early and mid-term outcomes of aggressive tricuspid annuloplasty with the MC3 ring

The study aim was to investigate the mid-term outcome of tricuspid annuloplasty (TAP) in the repair of functional tricuspid regurgitation (TR), using the three-dimensional (3D) MC3 ring with 'aggressive' stitches.

Between May 2007 and December 2012, a total of 165 patients (104 women, 61 men; mean age 68.0 ± 9.0 years) underwent TAP using the MC3 ring. Horizontal mattress sutures were placed on the annulus beyond the anteroseptal commissure and away from the deemed atrioventricular node artery/vein, which could be detected in the triangle of Koch. Transthoracic echocardiography was performed preoperatively and postoperatively. The severity of TR was graded from 0 to 4. The mean follow up was 30.3 ± 20.4 months.

Both, TR grade and pulmonary artery systolic pressure (PASP) were significantly improved postoperatively. After a median of 24 months, the mean TR grade and PASP remained satisfactory. The overall survival rates were 97.6% and 94.8% at one and four years, respectively. The rates of freedom from recurrent TR (grade > 2) were 97.3% and 90.5% at one and four years, respectively. There were neither impulse conduction disorders requiring new pacemaker implantation, nor reoperations for recurrent TR. Multivariate analysis showed that recurrent TR during the follow up period was significantly related to severe preoperative TR.

The clinical and echocardiographic results of TAP with the MC3 ring and 'aggressive' stitches were excellent, though further follow up is mandatory to confirm the safety and durability of this technique. Detection of the prominent vessel in the triangle of Koch can be helpful in avoiding impulse conduction disorders after TAP.