Optimizing ring selection for secondary tricuspid regurgitation: the role of body size.

Objectives: The goal of this study was to investigate whether a larger prosthetic ring relative to a patient's body surface area (BSA) is associated with an increased risk of tricuspid regurgitation (TR) recurrence after tricuspid annuloplasty and of adverse effects on long-term outcomes.

Methods: We retrospectively enrolled 239 patients who underwent tricuspid ring annuloplasty and mitral valve surgery between 2011 and 2016. The tricuspid annuloplasty ring index (TARI) was calculated by dividing the size of the annuloplasty ring (mm) by the BSA (m2). Risk factors for recurrent TR were determined using multivariate analysis. Long-term clinical outcomes were compared between propensity score matched large and small TARI groups.

Results: The annuloplasty ring size unadjusted for BSA did not affect TR recurrence (P = 0.388). TARI [subdistribution hazard ratio 1.34; 95% confidence interval (CI) 1.07-1.67, P = 0.009] and right ventricular dimension (P = 0.020) were independent risk factors for recurrent TR in multivariate analyses. The cut-off value for differentiating the small from the large TARI group was 19.0 mm/m2. In the matched cohort, the cumulative TR recurrence at 3 years postoperatively was 0% in the small TARI group and 7.1% (95% CI 0-14.8%) in the large TARI group (P = 0.025). The cumulative incidence of adverse events at 3 years postoperatively was 8.3% (95% CI 5.1-16.2%) in the small TARI group and 13.2% (95% CI 3.3-23.0) in the large TARI group (P = 0.085).

Conclusions: The patient's body size might better be considered when determining the tricuspid ring size.