Mid-term results of leaflet augmentation in severe tricuspid functional tethering.

Objectives: Functional tricuspid regurgitation (FTR) is usually managed surgically using various types of annuloplasty. FTR has been reported to recur in up to 45% of patients, with severe leaflet tethering being an important risk factor for recurrence. The aim of this study is to report the clinical and echocardiographic mid-term results after leaflet augmentation in patients with FTR due to severe leaflet tethering.

Methods: From May 2008 to July 2014, 22 patients were found to have a severe FTR with a tethering height of at least 8 mm; all of them underwent leaflet augmentation: the anterior and part of the posterior leaflet were detached from the anterior annulus; a patch of fresh autologous pericardium was used to generously fill the gap between the anterior annulus and the detached leaflet. A 5/0 Pronova suture locked at every step was used to avoid any purse string effect. In 2 patients, the septal leaflet also needed to be augmented using a comparable technique. In all but one (annular calcification) patient, a semi-rigid ring annuloplasty was added. The mean age was 67.1 ± 13.7 years; it was a redo procedure in 12 cases (54.5%), 11 patients (50%) had right ventricle failure and 3 (23.1%) had renal failure.

Results: The median follow-up was 2.1 ± 1.9 years. Thirty-day and 4-year survival averaged at 81.1 ± 8.5 and 71.6 ± 9.8%, respectively. At 4 years, 84 ± 10.6% of the survivors were in NYHA class I or II and only 2 patients had a TR of ≥2 with a global freedom from TR ≥2 of 85.7 ± 13.2%. There was no reintervention.

Conclusions: Tricuspid leaflet augmentation combined with annuloplasty is feasible and leads to excellent clinical and echocardiographical mid-term results even in the presence of severe leaflet tethering and right ventricular failure.