Carpentier's flexible ring versus De Vega's annuloplasty. A prospective randomized study

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Engineering

Background:

• Tricuspid regurgitation is a significant valvular heart disease.
• Surgical repair options include Carpentier's and De Vega's tricuspid annuloplasty.
• Comparative efficacy data for these techniques are crucial for clinical decision-making.

Purpose of the Study:

• To prospectively compare the long-term efficacy of Carpentier's tricuspid annuloplasty versus De Vega's technique.
• To evaluate the impact of organic tricuspid damage and pulmonary resistances on surgical outcomes.

Main Methods:

• 159 patients with moderate to severe tricuspid regurgitation were randomized to either Carpentier's (76) or De Vega's (83) annuloplasty.
• Follow-up averaged 64 months, assessing tricuspid insufficiency via clinical evaluation and contrast right ventriculography.
• Patient characteristics, including age, sex, mitral lesions, and aortic valvulopathy, were analyzed.

Main Results:

• Carpentier's annuloplasty demonstrated a significantly lower incidence of moderate or severe tricuspid insufficiency (4/40 vs. 14/41, p<0.01) at follow-up.
• In patients without organic tricuspid damage and with decreased pulmonary resistances, Carpentier's technique resulted in significantly less tricuspid regurgitation (1/40 vs. 9/19, p<0.01).
• Poor outcomes were observed in both groups with high pulmonary resistances or organic tricuspid damage.

Conclusions:

• Carpentier's tricuspid annuloplasty offers superior results compared to De Vega's technique for treating tricuspid regurgitation.
• The technique's effectiveness is particularly pronounced in cases without organic tricuspid damage and with favorable postoperative pulmonary hemodynamics.
• Careful patient selection and consideration of underlying pathology are essential for optimizing surgical outcomes in tricuspid annuloplasty.