Surgical tricuspid edge-to-edge repair: double-orifice repair versus clover repair

Surgical edge-to-edge repair has been proposed to treat tricuspid regurgitation with various aetiologies. Two techniques can be used for this repair: the 'double-orifice' and the 'clover' repairs. This study compares the clinical outcomes of these 2 techniques.

The study enrolled 258 patients who underwent tricuspid edge-to-edge repair out of 2257 tricuspid valve repairs between January 2001 and December 2021. Patients were categorized into 2 groups (double-orifice and clover repairs) and analysed using propensity score matching.

The mean age of the 258 patients was 60.8 ± 12.4 years, with 190 females (73.6%) and a mean EuroScore II of 4.6 ± 5.5. Of these, 169 underwent double-orifice repair and 89 clover repair, adjusted to 118 and 66 after matching, respectively. Using the reverse Kaplan-Meier method to account for censored data, the median follow-up duration [Q1-Q3] was 169 [76-229] months. Early mortality and morbidity did not differ significantly between the groups. Survival analysis did not show statistical differences in overall mortality and late severe tricuspid regurgitation recurrence between the groups. Similarly, freedoms from late significant tricuspid stenosis (trans-tricuspid pressure gradient ≥5 mmHg) and tricuspid reoperations [8 (4.7%) in the double-orifice repair group and 2 (2.2%) in the clover repair group] were not significantly different between the groups. The sensitivity analysis, which included the inverse probability of treatment weighting analysis, produced consistent results.

The surgical outcomes of tricuspid edge-to-edge repair were not statistically significantly different, regardless of the repair techniques. Both methods can be valuable options for tricuspid regurgitation repair.