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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 846-851, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Selective annuloplasty of the tricuspid valve. Two-year experience

C Minale, H Lambertz, S Nikol, N Gerich and BJ Messmer
Department of Thoracic and Cardiovascular Surgery, University Hospital of R.W.T.H., Aachen, Federal Republic of Germany.

Between July 1986 and March 1989, 48 patients whose ages averaged 60 +/- 6 years were subjected to a new technique for tricuspid valve annuloplasty. The preoperative New York Heart Association functional class averaged 3.7. There were 32 mitral-tricuspid procedures, 13 aortic-mitral-tricuspid procedures, and three repeat tricuspid annuloplasties. The hospital mortality rate was 6.3% with three deaths resulting from cardiac or respiratory failure, or both. Follow-up averaged 14 +/- 8 months. One patient (2.2%) died suddenly, 7 months postoperatively. All patients whose follow-up period lasted 6 months or more improved to class I or II. Twenty-six patients were reinvestigated by catheter or echocardiographic methods, or both. The gradient over the tricuspid valve averaged 1.4 +/- 0.6 mm Hg, and a moderate regurgitant murmur (2/3) was detected in four cases. The diameter of the tricuspidal anulus in the apical four-chamber view decreased from 23.7 +/- 3.9 mm/m2 body surface area preoperatively to 15.7 +/- 1.9 mm/m2 body surface area at late follow-up examination. The present technique allows an anatomic and functional reconstruction of the tricuspid valve with a good compromise between stenosis and regurgitation. The overall mortality rate is low and functional improvement is striking.

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