Pericardial Strip versus Ring Annuloplasty for Repair of Functional Tricuspid Regurgitation


Background: Functional tricuspid regurgitation is a challenge regarding indications for repair and proper surgical technique. Aim of the study: We reviewed our midterm results of tricuspid valve repair for functional regurgitation comparing pericardial strip versus ring annuloplasties. Patients and methods: From January 2008 to December 2013, we operated 59 patients (male:female, 41:18, with a mean age of 34 ± 14 years) for functional tricuspid regurgitation. Tricuspid annuloplasty was done using pericardial strip in 39 patients and ring in 20 patients. Concomitant procedures were mitral valve replacement in 66% of patients, aortic valve replacement in 5% and double valve replacement in 29%. Clinical and echocardiographic data were collected. Results: Preoperative characteristics of the two groups were similar regarding age, percentage of female patients, New York Heart Association functional class and pulmonary artery pressure. More patients with preoperative right ventricular dysfunction were found in pericardial annuloplasty group although this was not statistically significant (13 versus 5; P = 0.52). Operative times were similar in both groups. We had one mortality case (1.69%) due to low cardiac output in the pericardial group. Postoperative complications included reexploration for bleeding in one patient and chronic heart failure in another patient. The average follow up period was 3 years and it was complete in 100% of patients. Postoperative freedom from recurrent moderate tricuspid regurgitation was 90% in both groups. Conclusion: Pericardial strip annuloplasty is a simple, inexpensive, reproducible and efficient technique that has comparable results to ring annuloplasty.

Share and Cite:

Jabbad, H. , Elassal, A. and Eldib, O. (2014) Pericardial Strip versus Ring Annuloplasty for Repair of Functional Tricuspid Regurgitation. World Journal of Cardiovascular Surgery, 4, 239-244. doi: 10.4236/wjcs.2014.412035.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Badano, L.P., Muraru, D. and Enriquez-Sarano, M. (2013) Assessment of Functional Tricuspid Regurgitation. European Heart Journal, 34, 1875-1885.
[2] Nath, J., Foster, E. and Heidenreich, P.A. (2004) Impact of Tricuspid Regurgitation on Long-Term Survival. Journal of the American College of Cardiology, 43, 405-409.
[3] Rivera, R., Duran, E. and Ajuria, M. (1985) Carpentier’s Flexible Ring versus De Vega’s Annuloplasty. A Prospective Randomized Study. The Journal of Thoracic and Cardiovascular Surgery, 89, 196-203.
[4] Chang, B.C., Song, S.W., Lee, S., Yoo, K.J., Kang, M.S. and Chung, N. (2008) Eight-Year Outcomes of Tricuspid Annuloplasty Using Autologous Pericardial Strip for Functional Tricuspid Regurgitation. Annals of Thoracic Surgery, 86, 1485-1493.
[5] Raja, S.G. and Dreyfus, G.D. (2010) Basis for Intervention on Functional Tricuspid Regurgitation. Seminars in Thoracic and Cardiovascular Surgery, 22, 79-83.
[6] Nishimura, R.A., Otto, C.M., Sorajja, P., Sundt, T.M., Bonow, R.O., Carabello, B.A., Erwin III, J.P., et al. (2014) AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 63, e57-e185.
[7] Chan, V., Burwash, I.G., Lam, B.K., Auyeung, T., Tran, A., Mesana, T.G. and Ruel, M. (2009) Clinical and Echocardiographic Impact of Functional Tricuspid Regurgitation Repair at the Time of Mitral Valve Replacement. The Annals of Thoracic Surgery, 88, 1209-1215.
[8] Hwang, H.Y., Chang, H.W., Jeong, D.S. and Ahn, H. (2013) De Vega Annuloplasty for Functional Tricupsid Regurgitation: Concept of Tricuspid Valve Orifice Index to Optimize Tricuspid Valve Annular Reduction. Journal of Korean Medical Science, 28, 1756-1761.
[9] Minale, C., Lambertz, H. and Messmer, B.J. (1987) New Developments for Reconstruction of the Tricuspid Valve. The Journal of Thoracic and Cardiovascular Surgery, 94, 626-631.
[10] Simon, R., Oelert, H., Borst, H.G. and Lichtlen, P.R. (1980) Influence of Mitral Valve Surgery on Tricuspid Incompetence Concomitant with Mitral Valve Disease. Circulation, 62, I152-I157.
[11] Bernal, J.M., Morales, D., Revuelta, C., Llorca, J., Gutierrez-Morlote, J. and Revuelta, J.M. (2005) Reoperations after Tricuspid Valve Repair. The Journal of Thoracic and Cardiovascular Surgery, 130, 498-503.
[12] Poveda, J.J., Bernal, J.M., Matorras, P., Hernando, J.P., Oliva, M.J., Ochoteco, A. and Berrazueta, J.R. (1996) Tricuspid Valve Replacement in Rheumatic Disease: Preoperative Predictors of Hospital Mortality. Journal of Heart Valve Disease, 5, 26-30.
[13] Al-Ebrahim, K.E. (2010) Tricuspid Valve Replacement Is an Unfavorable Operation. Letter to the Editor. European Journal of Cardio-Thoracic Surgery, 38, 115.
[14] McCarthy, P.M., Bhudia, S.K., Rajeswaran, J., Hoercher, K.J., Lytle, B.W., Cosgrove, D.M. and Blackstone, E.H. (2004) Tricuspid Valve Repair: Durability and Risk Factors for Failure. Journal of Thoracic and Cardiovascular Surgery, 127, 674-685.
[15] Khorsandia, M., Banerjeeb, A., Singhb, H. and Srivastava, A.R. (2012) Is a Tricuspid Annuloplasty Ring Significantly Better than a De Vega’s Annuloplasty Stitch When Repairing Severe Tricuspid Regurgitation? Interactive CardioVasc Thoracic Surgery, 15, 129-135.
[16] Tang, G.H., David, T.E., Singh, S.K., Maganti, M.D., Armstrong, S. and Borger, M.A. (2006) Tricuspid Valve Repair with an Annuloplasty Ring Results in Improved Long-Term Outcomes. Circulation, 114, I-577-I-581.
[17] Al-Ebrahim, K. and Alassal, A. (2010) Autologous Pericardial Strip Repair of the Tricuspid Valve. Annals of Thoracic Surgery, 89, 674.
[18] Bernal, J.M., Gutiérrez-Morlote, J., Llorca, J., San José, J.M., Morales, D. and Revuelta, J.M. (2004) Tricuspid Valve Repair: An Old Disease, a Modern Experience. Annals of Thoracic Surgery, 78, 2069-2074.

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.