Tricuspid Annuloplasty: A Modified Technique

doi:10.1016/S0003-4975(10)61084-3

The Annals of Thoracic Surgery

Volume 35, Issue 6, June 1983, Pages 676-678

https://doi.org/10.1016/S0003-4975(10)61084-3 Get rights and content

Abstract

A modification of the de Vega semicircular annuloplasty for tricuspid regurgitation is presented. This technique has been used successfully in 48 patients since January, 1979.

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Cited by (50)

De Vega annuloplasty. Fifty years since the beginning of selective, adjustable and permanent valve repair
2023, Cirugia Cardiovascular
La anuloplastia de De Vega consiste en una doble sutura apoyada en parches de teflón en sus extremos y anudada de tal forma que corrige la regurgitación en la válvula tricúspide. Tras 50 años desde su publicación, se repasan sus antecedentes históricos, la técnica original y las sucesivas modificaciones que han ido surgiendo bajo el mismo concepto fisiopatológico. La anuloplastia de De Vega ha sido empleada extensamente en todo el mundo para corregir la insuficiencia tricúspide, especialmente aquella regurgitación secundaria funcional de forma concomitante a la cirugía de la válvula mitral. También se ha empleado en lesiones traumáticas, trasplante cardiaco o población infantil. En comparación con la anuloplastia con anillo rígido o semirrígido parece conferir menor estabilidad en el tiempo, sin que ello se haya traducido en un aumento de la morbimortalidad o la tasa de reintervenciones. Es una técnica rápida, sencilla, reproducible, económica, segura y que ofrece excelentes resultados clínicos en pacientes seleccionados. Tras 50 años sigue vigente especialmente como tratamiento de la insuficiencia tricúspide funcional no severa en el contexto de una cirugía valvular izquierda sin dilatación significativa del ventrículo derecho.
De Vega annuloplasty consists of a double suture supported by Teflon patches at its ends and tied in such a way as to correct regurgitation in the tricuspid valve. After 50 years since its publication, its historical background, the original technique and the successive modifications that have emerged under the same pathophysiological concept are reviewed. De Vega annuloplasty has been used extensively throughout the world to correct tricuspid insufficiency, especially secondary functional regurgitation concomitantly with mitral valve surgery. It has also been used in traumatic injuries, heart transplantation or the child population. Compared with annuloplasty with a rigid or semirigid ring, it seems to confer less stability over time, without this having translated into an increase in morbidity and mortality or in the rate of reinterventions. It is a fast, simple, reproducible, economical, safe technique that offers excellent clinical results in selected patients, and that after 50 years is still valid, especially as a treatment for non-severe functional tricuspid regurgitation in the context of left valve surgery without significant dilatation of the right ventricle.
Tricuspid valve surgery
2022, Revista Medica Clinica Las Condes
La insuficiencia tricúspidea (IT) es la lesión mas frecuente encontrada en la válvula. La IT leve es común y generalmente benigna. Sin embargo, la IT moderada y/o severa puede llevar a daño miocárdico irreversible y resultados adversos. A pesar de esto, pocos pacientes con IT significativa llegan a ser operados para corregir el defecto, aun habiéndose demostrado ser incorrecto que la resolución de la IT funcional ocurre por si sola una vez que se trata en forma exitosa la causa de base. El tratamiento de la IT secundaria o funcional permenece controversial debido a las altas tasas de IT residual o recurrencia después de la cirugía. Esta revisión pretende clarificar el manejo de la IT describiendo la anatomía, fisiopatología, diagnóstico, y tratamiento quirúrgico, incluyendo la terapia percutanea.
Tricuspid regurgitation (TR) is a manifestation of valvular heart disease due to the primary involvement of the valve or secondary to pulmonary hypertension or to the leftsided heart valve disease. The pathophysiology of secondary TR is complex and is intrinsically connected to the anatomy and function of the right ventricle. A better approach to diagnosis and assessment based on the severity of the TR, annular size, RV function and degree of pulmonary hypertension is needed. Nowadays, treatment of secondary TR is currently an essential concomitant procedure at the time of mitral surgery. Although the indications for surgical management of severe TR are now generally accepted, controversy persists related to the role of intervention for moderate TR. However, there is a trend in this setting, especially at the time of surgery for leftsided heart valve disease with significant tricuspid annular dilatation. Surgery remains the best approach for treatment of TR. Percutaneous tricuspid valve intervention but may become a reliable option in future, especially for high-risk patients with isolated primary TR or with secondary TR related to advanced left-sided heart valve disease.
Insight into functional tricuspid valve regurgitation pathogenesis, pathological stages, and surgical management
2021, International Journal of Cardiology
Citation Excerpt :
The RV is still spared maintaining its cone shape and systolic function with end-diastolic RV eccentricity index ≤2. [14] Any modified De Vega annuloplasties, in particular those described by Antunes, [22] Revuelta, [23] and Sarraj [24] could be enough to deal with TR and restore normal function. [25] However, a ring tricuspid annuloplasty is likely indicated in the presence of severe PHT.
The tricuspid valve has generally been ignored, and considered as a “second class structure” in cardiac valve surgery. Tricuspid valve regurgitation is considered “functional” in over 70% of cases, generally produced by pulmonary hypertension secondary to left heart diseases in the context of an anatomically normal tricuspid valve apparatus. Many questions and doubts persist regarding to the pathogenesis of so-called functional tricuspid valve regurgitation. This article reviews the interfering factors in the function of the tricuspid valve to better identify the entity of the term “functional” and clarify its different pathological stages including the surgical procedures recommended in each stage.
Concomitant Tricuspid Valve Repair During Mitral Valve Repair: An Analysis of Techniques and Outcomes
2020, Journal of Cardiothoracic and Vascular Anesthesia
Citation Excerpt :
Pericardial pledgets can be used for patients with endocarditis in whom it is prudent to reduce the amount of foreign material. If the tissue is thin, an additional single pericardial pledget in the midpoint of the posterior leaflet or multiple Teflon pledgets buttressed to each bite will help prevent suture dehiscence.68 This technique is more widely used around the world because of its inexpensive nature and the extensive experience with it.
Tricuspid Annular Geometry and Strain After Suture Annuloplasty in Acute Ovine Right Heart Failure
2018, Annals of Thoracic Surgery
Tricuspid valve repair using suture annuloplasty is thought to be more physiologic, but the effect of annular reduction on annular geometry and motion is unknown. We set out to investigate the effect of DeVega suture annuloplasty (DV) on tricuspid annular geometry and dynamics during acute right heart failure (RHF).
Ten adult sheep underwent implantation of sonomicrometry crystals around the tricuspid annulus and on the right ventricle; pressure transducers were placed in right ventricle, left ventricle, and right atrium. RHF was induced by a combination of 500 mL volume infusion, posterior descending artery occlusion, and pulmonary artery constriction. Hemodynamic, echocardiographic, and sonomicrometry data were acquired at baseline, with RHF, and after two progressive (8 to 10 mm) DV suture cinches (DV-1, DV-2) during RHF. Annular size, geometry, and dynamics were determined from crystal coordinates.
Combination of volume infusion, ischemia, and pulmonary hypertension resulted in acute RHF and significant functional tricuspid regurgitation grade (0.5 ± 0.5 versus 2.7 ± 0.8, p < 0.001). Annular area increased with RHF from 700 ± 98 mm² to 801 ± 128 mm² (p < 0.001). DV-1 and DV-2 reduced annular area to 342 ± 88 mm² and 180 ± 57 mm² while reducing regurgitation grade to 1.2 ± 0.4 and 0.4 ± 0.5, respectively (all p < 0.001 versus RHF). Tricuspid annular area contraction was 12% ± 7%, 10% ± 6%, and 12% ± 6% for RHF, DV-1, and DV-2, respectively (p = 0.25) and annular height was 4.9 ± 2.0 mm, 5.6 ± 1.4 mm, and 5.5 ± 1.7 mm (p = 0.43). Mean transvalvular gradient was 1.3 ± 0.7 mm Hg and 2.0 ± 1.0 mm Hg with DV-1 and DV-2, respectively.
During acute ovine RHF, DeVega annuloplasty successfully treated tricuspid regurgitation and preserved normal tricuspid annular dynamics and geometry. These data may lead to more physiologic tricuspid reparative techniques.
Tricuspid valve repair with Dacron band versus DeVega or segmental annuloplasty. Hospital outcome and short term results
2017, Egyptian Heart Journal
Citation Excerpt :
However, other investigators have reported a relatively high recurrence rate for the DeVega technique,7,25 particularly in patients with severe tricuspid annular dilation and/or pulmonary hypertension.19 It has been recommended that such patients undergo TV repair with an annuloplasty ring.7,25–33 We therefore undertook the current study to compare hospital outcome and short-term results in patients undergoing TV repair with three repair techniques.
The purpose of this study was to compare the hospital outcome and short term results of tricuspid valve (TV) repair with three repair techniques for functional tricuspid regurgitation (TR), namely, flexible Dacron band, DeVega and segmental annuloplasty.
A total of 60 patients underwent TV repair at National Heart Institute from January 2013 to November 2014, of which 20 had DeVega procedure (DV), 20 had a segmental annuloplasty (SA) procedure and 20 had a Dacron band (DB) procedure. Concomitant procedures done for rheumatic left sided valve pathology consisted of mitral valve replacement in 70% of patients, and double valve replacement in 30% of patients. Clinical and echocardiographic follow-up data were obtained. Follow-up was 100% complete and was concluded after one year.
All demographic criteria and preoperative characteristics of the three studied groups were comparable except for preoperative right ventricular (RVEDD) size that was significantly bigger in Dacron band group as compared to the other two groups (3.18 ± 0.43 cm compared to 3.00 ± 0.33 cm (DV) and to 2.88 ± 0.35 cm (SA), p value of (0.045)). Similarly, all operative and postoperative criteria were comparable among the study groups. Noticeably, (RVEDD) size remodeled better postoperatively in (DB) group as compared to the other two groups, (2.54 ± 0.26 cm compared to 2.83 ± 0.311 cm (DV) and to 2.72 ± 0.29 cm (SA), mean difference values were group (0.64 ± 0.47 cm) for (DB) compared to (0.18 ± 0.29 cm) for (DV) or to (0.16 ± 0.45 cm) for (SA) with p value of 0.000. The majority of patients in each group did not have tricuspid regurgitation (TR) or mild degree (+1) of (TR) on discharge. After one year of follow-up, most of the patient had either no regurgitation or grade (+1 TR). Two patients (10%) in DV group and one patient (5%) in SA group had (+3 TR). There was no statistical significance in the incidence of hospital mortality, only one patient died in DB and one in DV group (5%) and no death happened after hospital mortality for the three groups after one year.
The three techniques are options to repair the tricuspid valve, however, placement of Dacron band in patients undergoing tricuspid valve repair is associated with better RV remodelling, and hence, a probable better right ventricular performance and better outcome of repair is expected. A higher number of patients are needed with longer follow up period to appreciate the effect on survival and rate of freedom from tricuspid regurgitation and re-intervention.

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Tricuspid Annuloplasty: A Modified Technique

Abstract

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement

Circulation

Tricuspid replacement for acquired valve disease

Surg Gynecol Obstet