Eight-Year Outcomes of Tricuspid Annuloplasty Using Autologous Pericardial Strip for Functional Tricuspid Regurgitation

Background: Although several techniques of tricuspid annuloplasty have been used to treat tricuspid regurgitation (TR), TR can persist or recur with redilatation of the annulus or disease progression. We compared the long-term results of newly developed tricuspid annuloplasty procedure using autologous pericardial strip with that of conventional suture annuloplasty. Methods: From January 1997 to April 2006, 334 patients (mean age, 52.7 years) underwent tricuspid annuloplasty for functional TR. Concomitant procedures included mitral valve replacement in 261 patients and mitral-aortic valve replacement in 73. We performed conventional suture annuloplasty (De Vega or Kay) in 117 patients and autologous pericardial strip annuloplasty in 217 patients. Results: There were 8 in-hospital deaths (mortality, 2.4%). Mean follow-up was 42.1 months, and total follow-up duration was 1,145 patient-years. Significant TR before discharge was noted in 34 patients (11.1%). The severity of TR improved with time in the autologous pericardial strip annuloplasty group; however, it became worse in conventional suture annuloplasty group (p = 0.05). Multivariate analysis demonstrated that preoperative severity of TR and conventional suture annuloplasty were significant predictors of recurrent TR. Overall survival was comparable between two groups (p = 0.742); however, recurrence-free survival was better for the autologous pericardial strip annuloplasty group than for the conventional suture annuloplasty group (86.8% versus 71.9%; p = 0.039). Conclusions: The long-term recurrence-free survival after autologous pericardial strip annuloplasty appeared to be better than that of conventional suture annuloplasty. Autologous pericardial strip annuloplasty appears to be a simple, easily reproducible, and valid option for surgical treatment of functional TR.