Published: 2018-01-24

De Vega annuloplasty versus ring annuloplasty for repair of functional tricuspid regurgitation

Khaled Alnawaiseh, Bashar Albkhoor, Yanal Alnaser, Hayel Aladwan, Issa Ghanma


Background: Tricuspid insufficiency (TI) is a functional insufficiency in most of the cases and associated with the dilatation of the annulus and remolding. Pulmonary hypertension and right ventricular volume overload due to chronic aortic or / and mitral valve disease in most of the time causes the functional tricuspid insufficiency. Despite the different techniques used to repair the tricuspid valve, the recurrent TR is still occurring in 20- 30 % of the patients and the development of late TR is an important complication of left heart surgery. Our study aims to compare the long-term outcome of ring annuloplasty with De Vega annnuloplasty in patients with secondary tricuspid regurgitation (TR).

Methods: A retrospective study of 320 patients who underwent tricuspid valve repair surgery for secondary tricuspid regurgitation from January 2002 to December 2010 at Queen Alia Heart Institute (QAHI). Patients were divided into two groups, in group (1) (n=180) patients had an annuloplasty ring. Group (2) (n=140) patients had De Vega procedure (no ring). The procedures were performed in association with mitral valve surgery in 78% of patients, aortic valve surgery in 15% and combined aortic and mitral valve surgery in 7% of patients. TR grade, NYHA functional class and Pulmonary artery pressure were nearly similar and no significant preoperative difference between the two groups.

Results: Echocardiographic and clinical follow up were done for all patients. The duration of procedure for both De Vega and ring annuloplasty were nearly similar. The overall survival in ring group at 5year was 83.9% versus 77.9% in De Vega group. Freedom from residual and recurrent TR, event free survival and long-term survival were significantly better in the ring group and also the tricuspid valve reoperation were less in the ring group.

Conclusions: The implantation of annuloplasty ring results in lower incidence of residual or recurrent of tricuspid regurgitation, improved the event-free survival and long-term survival when compared with the sewing techniques such as De Vega.


Cardiac surgery, De Vega, incompetence, repair, ring, tricuspid valve, outcome

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Mancini MC. Tricuspid Regurgitation Differential Diagnoses. Available at https://emedicine.staging. Accessed Jun 02, 2014.

Tei C, Kisanuki A, Minagoe S, Shibata K, Yutsudou T, Otsuji Y, et al. Incidence of tricuspid regurgitation in normal subjects according to a new Doppler echographic criterion. J Cardiol. 1987;17(3):551-8.

Rodríguez-Capitán J, Gómez-Doblas JJ, Fernández-López L, López-Salguero R, Ruiz M, Leruite I, et al. Short-and long-term outcomes of surgery for severe tricuspid regurgitation. Revista Española de Cardiología (English Edition). 2013;66(8):629-35.

Rodés-Cabau J, Taramasso M, T O'Gara P. Diagnosis and treatment of tricuspid valve disease: current and future perspectives. Lancet. 2016;388(10058):2431-42.

Sung K, Park PW, Park KH, Jun TG, Lee YT, Yang JH, et al. Is tricuspid valve replacement a catastrophic operation?. Euro J Cardio-Thoracic Surg. 2009;36(5):825-9.

Sadeghpour A, Hassanzadeh M, Kyavar M, Bakhshandeh H, Naderi N, Ghadrdoost B, Talab AH. Impact of severe tricuspid regurgitation on long term survival. Res Cardio Med. 2013;2(3):121.

Antunes MJ, Barlow JB. Management of tricuspid valve regurgitation. Heart. 2007;93(2):271-6.

Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114(5):84-231.

Wang H, Liu X, Wang X, Lv Z, Liu X, Xu P. Comparison of outcomes of tricuspid annuloplasty with 3D-rigid versus flexible prosthetic ring for functional tricuspid regurgitation secondary to rheumatic mitral valve disease. J Thoracic Dis. 2016;8(11):3087.

Izutani H, Nakamura T, Kawachi K. Flexible band versus rigid ring annuloplasty for functional tricuspid regurgitation. Heart international. 2010;5(2).

Tang GHL, David TE, Singh SK, Maganti MD, Armstrong S, Borger MA. Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes. Circulation. 2006;114:577-81.

Sultan FA, Moustafa SE, Tajik J, Warsame T, Emani U, Alharthi M, et al. Rheumatic tricuspid valve disease: an evidence-based systematic overview. J Heart Valve Dis. 2010;19(3):374-82.

Grossmann G, Stein M, Kochs M, Höher M, Koenig W, Hombach V, et al. Comparison of the proximal flow convergence method and the jet area method for the assessment of the severity of tricuspid regurgitation. Euro Heart J. 1998;19(4):652-9.

Porter A, Shapira Y, Wurzel M, Sulkes J, Vaturi M, Adler Y, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J heart Valve Dis. 1999;8(1):57-62.

Yada I, Tani K, Shimono T, Shikano K, Okabe M, Kusagawa M. Preoperative evaluation and surgical treatment for tricuspid regurgitation associated with acquired valvular heart disease. The Kay-Boyd method vs the Carpentier-Edwards ring method. J Cardio Surg. 1990;31(6):771-7.

Cosgrove DM, Arcidi JM, Rodriguez L, Stewart WJ, Powell K, Thomas JD. Initial experience with the Cosgrove-Edwards Annuloplasty System. Ann Thorac Surg. 1995;60:499-503.

Bianchi G, Solinas M, Bevilacqua S, Glauber M. Which patient undergoing mitral valve surgery should also have the tricuspid repair? Interact Cardiovasc Thorac Surg. 2009;9:1009-20.

Irwin RB, Luckie M, Khattar RS. Tricuspid regurgitation: contemporary management of a neglected valvular lesion. Postgrad Med J. 2010;86:648-55.

Breyer RH, McClenathan JH, Michaelis LL, McIntosh CL, Morrow AG. Tricuspid regurgitation. A comparison of nonoperative management, tricuspid annuloplasty, and tricuspid valve replacement. J Thoracic Cardio Surg. 1976;72(6):867-74.

Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T. Predictors of residual tricuspid regurgitation after mitral valve surgery. Annals Thoracic Surg. 2003;75(6):1826-8.

Duran CM, Pomar JL, Colman T, Figueroa A, Revuelta JM, Ubago JL. Is tricuspid valve repair necessary?. J Thoracic Cardio Surg. 1980;80(6):849-60.

King RM, Schaff HV, Danielson GK, Gersh BJ, Orszulak TA, Piehler JM, et al. Surgery for tricuspid regurgitation late after mitral valve replacement. Circulation. 1984;70(3 Pt 2):I193-7.

Bernal JM, Morales D, Revuelta C, Llorca J, Gutiérrez-Morlote J, Revuelta JM. Reoperations after tricuspid valve repair. J Thoracic Cardio Surg. 2005;130(2):498-503.

Rivera R, Duran E, Ajuria M. Carpentiers Flexible ring versus De Vega anuuloplasty. A prospective randomized study. J Thorac Cardiovasc Surg. 1985;89:196-203.

Vigano G, Guidotti A, Taramasso M, Giacomini A, Alfieri O. Clinical mid-term results after tricuspid valve replacement. Interact Cardiovasc Thorac Surg. 2010;10:709-13.

McCarthy PM, Bhudia SK, Rajeswaran J, Hoercher KJ, Lytle BW, Cosgrove DM, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg. 2004;127:674-85.

Ren WJ, Zhang BG, Liu JS, Qian YJ, Guo YQ. Outcomes of tricuspid annuloplasty with and without prosthetic rings: a retrospective follow-up study. J Cardiothoracic Surg. 2015;10(1):81.