Predictors of Failure after DeVega Repair for Functional Tricuspid Regurgitation

Hysam  Abdelmohty; Wael  Abdelaziz; Mohamed-Adel  Elanwar; Ehab  Abdelazeem; Mohamed  Ali; Basem Abdelgawad

doi:10.35810/ects.v3i3.184

Hysam Abdelmohty Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Wael Abdelaziz Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mohamed-Adel Elanwar Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Ehab Abdelazeem Department of Anesthesia and Intensive Care, Faculty of Medicine, Benha University, Benha, Egypt
Mohamed Ali Department of Cardiology, Faculty of Medicine, Benha University, Benha, Egypt
Basem Abdelgawad Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt

DOI: https://doi.org/10.35810/ects.v3i3.184

Keywords: Functional Tricuspid regurgitation, Tricuspid repair, De Vega annuloplasty, Mitral valve replacement

Abstract

Background: Untreated tricuspid regurgitation during mitral valve surgery may progress to severe symptomatic tricuspid regurgitation. Concomitant repair may increase the operative risk; however, re-operative tricuspid valve surgery is a high-risk procedure. This study's objective was to identify the predictors of DeVega repair failure in patients with functional tricuspid regurgitation and concomitant mitral valve surgery.

Methods: This research is a retrospective comparative study that included 140 patients who underwent tricuspid valve repair concomitant with mitral valve replacement. We divided the patients into two groups; the first group (n=106) included patients with no DeVega failure at six-months follow-up (The sustained repair group). The second group included 34 patients who developed moderate or higher TR after the DeVega and was named the failed repair group.

Results: The demographic data and comorbidities were not statistically different between both groups. The preoperative atrial fibrillation (73 (69%) vs. 30 (88%)’ p= 0.027) pulmonary artery pressure (64.8±3.6 vs. 81±6.5 mmHg; p= 0.02), right ventricular dimension (4.85±0.24 vs. 5.23±0.37 cm; p= 0.03), and time between the indication of surgery and operation (8.3 ± 3.1 vs. 14.7 ± 5.4 months; p = 0.003) were higher in patients with failed DeVega repair. There was no statistically significant difference regarding the mean bypass time, cross-clamp time, ICU and hospital stay, and postoperative complications between both groups. Predictors of failure after six months were preoperative heart failure (OR: 15.4 (95% CI: 3- 92.3); p= 0.003), long time between diagnosis and surgery (OR: 12.3 (95% CI: 2.1- 84.7); p= 0.007), and postoperative severe pulmonary hypertension (OR: 24.7 (95% CI: 3.1- 199.6); p= 0.003).

Conclusions: DeVega repair is associated with a high failure rate after six months. The study of predictors of failure could change our management plans to reach the best results for repair.