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J Thorac Cardiovasc Surg 2007;133:125-126
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr P. McCarthy (Chicago, Ill). Congratulations, Dr. Ghanta, on an excellent paper and presentation. They say that beauty is in the eye of the beholder—and so it is with this paper from the Brigham regarding tricuspid valve repair in patients with functional TR. One could say that the results of bicuspidization for TV repair are equal to that of ring annuloplasty, but one could also say that both are equally bad. Three years postoperatively, 3 or 4+ TR was present still in 25% of the bicuspidization patients and 31% of the ring patients. These are clearly not results that we would accept in patients undergoing valve repair for a condition such as myxomatous mitral regurgitation, for which we are now recommending surgery for patients with asymptomatic disease, because the repairs are very durable.

For some reason, we as surgeons have come to accept that a significant percentage of our patients who undergo tricuspid repair will redevelop significant TR. While it may not always be clinically significant early after surgery, increasing clinical evidence indicates that over time the patient will suffer for this.

I would like to note one clarification regarding your paper. Your grading of TR indicates that moderate is 3+. This is consistent with the STS database. Unfortunately, we have a disconnect with our colleagues in cardiology such that the American Society of Echo refers to 3+ regurgitation as moderate to severe, and in their system moderate is only 2+. Just to clarify for the audience, then, when you are referring to moderate regurgitation in this paper, it is 3+. Anytime we see a patient who redevelops 3 or 4+ regurgitation, we should consider that a failure of the repair technique.

I have three questions. Your study has the usual problems with a retrospective study in that . . . [Full Text of this Article]

Related Article

Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation: Midterm results of 237 consecutive patients

Ravi K. Ghanta, Raymond Chen, Narendren Narayanasamy, Siobhan McGurk, Stuart Lipsitz, Frederick Y. Chen, and Lawrence H. Cohn
J. Thorac. Cardiovasc. Surg. 2007 133: 117-126. [Abstract] [Full Text] [PDF]