Results of Isolated Tricuspid Aortic Valve Repair

Background: Isolated repair of the regurgitant tricuspid aortic valve (TAV) has become an increasingly attractive alternative to replacement, even though data on the midterm durability are scarce. We analyzed the midterm results of TAV repair in a relevant patient cohort to determine, whether the mechanism of regurgitation or operative technique influence survival or repair stability.

Method: Between December 1997 and August 2014, 264 patients underwent isolated TAV repair in our institution. The mean age was 59 ± 16 years. 77% (n = 203) were male. Clinical and operative data were recorded. The patients were followed clinically and echocardiographically.

Results: Survival was 76.7 ± 3.5% and 57.2 ± 11.5% after 10 and 15 years (median = 224 months). Intraoperative measurement of effective height (eH) was significantly associated with improved long-term survival (p = 0.001). Cumulative freedom from reoperation was 88.7 ± 2.1% after 5 and 77.4 ± 3.9% after 10 years. Cumulative freedom from AI > II° was 85.9 ± 2.5% and 66.9 ± 5.2% after 5 and 10 years. Freedom from AI > II° and reoperation was significantly higher in patients with prolapse of the aortic valve compared with retraction as primary regurgitation mechanism (p = 0.000 and 0.001). A circular suture annuloplasty was associated with a trend to higher freedom from AI > II° (p = 0.053).

Conclusion: Long-term survival after isolated TAV repair is good considering the age of the patient population. TAV repair for cusp retraction has a poorer durability compared with repair of prolapse. The application of effective height in controlling TAV repair is associated with improved survival. The use of a circular annuloplasty is of only of borderline significance in TAV repair.

Publication History

Article published online:
12 February 2022