MP03. Anterior Leaflet‑Oriented Tricuspid Annuloplasty Using a Flexible Ring for Tricuspid Regurgitation

New York Hilton Midtown 

Objective: Multiple fashions of tricuspid annuloplasty have been introduced to clinical arena; however, residual or recurrent moderate/severe TRs have been documented in unignorable proportion of patients after tricuspid annuloplasty. Kasegawa et al. have introduced a new concept of tricuspid ring annuloplasty (TRA) called anterior leaflet-oriented annuloplasty (ALOA). The purpose of this study is to evaluate preliminary early outcomes of our TRA with ALOA for patients with TR.
Methods: From November 2019 through January 2023, we performed TRA employing ALOA, "Kasegawa method", for 38 patients (66.4±15.8 years, 20 males) with primary or secondary TR. Preoperative data and postoperative echocardiographic indices were retrospectively assessed by chart review. TRA with ALOA is composed of the concept and technical details as follow. The goal for TRA using a flexible ring is to have an annuloplasty ring conform to the configuration of each patient's anterior leaflet. The most important concept of the method is to reduce the size of the tricuspid annulus sufficiently enough by respecting individual configuration of the anterior leaflet to create generous coaptation area for the leaflets without a concomitant additional sub-valvular procedure. The size of the flexible ring is selected based on the measurement of the surface area of the anterior leaflet. Technical knacks include, while inspecting both the annulus and a ring, 5 or 6 narrow mattress stiches are placed 1–2 mm outside of the anterior annulus, and passed through the opposing part of a seated ring, then tied down.
Results: All the TRA procedures were performed under beating heart condition. Concomitant procedures included AVR in 10 patients, MVR in 10, MVP in 18, CABG in 2, and other 32 miscellaneous procedures were also performed. TR grade was significantly mitigated from 3.4±0.6 preoperatively to 1.9±0.7 at 6 months postoperatively (p<0.01). IVC diameter also decreased from 19.4±5.6 to 16.1±3.9 (p<0.05). Of note, tricuspid annular plane systolic excursion, TAPSE, dropped from preoperative 18.7±6.5 mm to immediately postoperative 9.7±3.0 mm, yet gradually improved to 12.7±3.5 at 6 months, 13.3±4.3 at 12 months and 14.8±3.2 mm over the period of 15 months.
Conclusions: Tricuspid flexible ring annuloplasty adopting anterior leaflet-oriented annuloplasty may confer a long-term benefit to right ventricular function in addition to durable control of residual tricuspid regurgitation.