Materials and Methods
This study was approved by the Osaka City University Ethical Review Board (approval no. 3556). Informed consent was obtained from all patients using an opt-out method.
From April 2016 to November 2020, 187 patients were diagnosed with secondary TR associated with left heart disease and underwent TV repair. Indication of TV repair was followed the 2020 Japan JCS/JSCS/JATS/JSVS Guideline (11).
All patients underwent tricuspid annuloplasty using a Carpentier-Edwards Physio Tricuspid Annuloplasty Ring (Edwards Lifesciences, Irvine, CA, USA) or Tailor Flexible Annuloplasty Ring (Abbott, Menlo Park, CA, USA). The exclusion criteria were infective endocarditis and primary TR. Patients without perioperative echocardiographic data and patients who underwent re-do TV repair were also excluded. Finally, we analyzed 141 patients with secondary TR due to TV annular dilatation (Fig.1).
We divided the patients into two groups: Group 1 comprised patients who underwent only ring annuloplasty for TR, and Group 2 comprised patients who required additional approximation of leaflet edges (edge-to-edge repair) with ring annuloplasty to reduce residual TR. We retrospectively examined the patients’ background data, preoperative transthoracic echocardiography data, surgical procedures, and anatomical features of the posterior leaflets and compared these data between the two groups. We also analyzed the risk predictors of the need for additional procedures to reduce TR. Finally, we assessed preoperative and postoperative echocardiographic parameters between patients with one posterior valve leaflet and patients with two posterior valve leaflets.