Document Detail

Is a tricuspid annuloplasty ring significantly better than a De Vega's annuloplasty stitch when repairing severe tricuspid regurgitation?
MedLine Citation:
PMID:  22457189     Owner:  NLM     Status:  MEDLINE    
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether tricuspid valve (TV) repair with an annuloplasty ring leads to an improved outcome over a conventional suture annuloplasty for patients with severe tricuspid incompetence. Altogether, 306 papers were found using the reported search, of which 14 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We found seven studies supporting the use of ring annuloplasty over De Vega's suture annuloplasty. Five studies found no significant difference in outcome between the two techniques. We found only two studies supporting the use of De Vega's suture annuloplasty over ring annuloplasty. Therefore, most of the tabulated studies show good evidence in support of ring annuloplasty compared with De Vega's suture repair for treatment of moderate to severe TV regurgitation. One cohort study identified a 20.4% postoperative failure rate for tricuspid regurgitation (TR) repair and concluded non-application of ring as a predictor for reoperation. One cohort study with a mean follow-up of 17 months reported success rates as high as 97% with ring annuloplasty for TV regurgitation. One large cohort study of 2277 patients with TR who had undergone repair reported a sustained reduction in TR and the rate of recurrence in a 5-year echocardiographic follow-up. One cohort study of 129 patients concluded that ring annuloplasty has the lowest rate of recurrence compared with De Vega's suture repair. An old randomized controlled trial (RCT) on the subject also reported a similar result to the mentioned studies. In contrast, we reviewed one recent study and four older studies and found no significant difference between the two techniques. We reviewed one study that reported De Vega's suture repair as a superior technique to ring annuloplasty. We conclude that there is good evidence supporting ring annuloplasty over conventional De Vega's suture annuloplasty.
Maziar Khorsandi; Amit Banerjee; Harpreet Singh; Aseem R Srivastava
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Publication Detail:
Type:  Journal Article; Review     Date:  2012-03-28
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-22     Completed Date:  2012-10-29     Revised Date:  2013-07-02    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  129-35     Citation Subset:  IM    
Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
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MeSH Terms
Cardiac Valve Annuloplasty / adverse effects,  instrumentation*,  mortality
Evidence-Based Medicine
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / adverse effects,  instrumentation*,  mortality
Prosthesis Design
Risk Assessment
Risk Factors
Severity of Illness Index
Suture Techniques* / adverse effects,  mortality
Time Factors
Treatment Outcome
Tricuspid Valve Insufficiency / diagnosis,  mortality,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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