Failure of Tricuspid Annuloplasty for Functional Tricuspid Regurgitation: Impact of Patient's Body Size

Tricuspid repair is recommended for significant functional tricuspid regurgitation (FTR) or tricuspid annulus (TA) dilation, based on TA >40 mm or >21 mm/m(2). The concordance between both TA dimensions related to the patient's body size has not been investigated. Patients who underwent rigid ring tricuspid annuloplasty for FTR between 2009 and 2017 were included. Assuming equality between both TA diameter criteria, patients were divided per body surface area (BSA): group 1 = BSA <= 1.9 m(2) and group 2 = BSA >1.9 m(2). The primary outcome was TR recurrence at 5 years. Tricuspid annuloplasty was performed in 186 patients (group 1: 130 patients [69.9%]; group 2: 56 patients [30.1%]). Group 1 comprised more female (70.8% to 23.2%, p <0.001) and older patients (77.1 +/- 9.3 years; 74.2 +/- 8.2 years, p = 0.048). Group 1 had a smaller absolute TA diameter (group 1: 45.3 +/- 5.2 mm; group 2: 48.2 +/- 5.6 mm, p <0.001), whereas the indexed TA size was inversely higher (group 1: 26.3 +/- 3.4 mm/m(2); group 2: 24.2 +/- 2.7 mm/m(2), p <0.001). The tenting height was comparable (group 1: 7.8 +/- 3.0 mm; group 2: 8.0 +/- 2.7 mm, p = 0.714). The median ring size was 30 (interquartile range 28 to 32) and 32 (interquartile range 30 to 34) for groups 1 and 2, respectively (p <0.001). TR recurrence at 5 years was noticed in 20.2% and 6.5% of group 1 and 2 (p = 0.035). Indexed TA diameter (hazard ratio 1.43, 95% confidence interval 1.10 to 1.87, p = 0.008) and tenting height (hazard ratio 5.52, 95% confidence interval 1.87 to 14.57, p = 0.002) were independent predictors of TR recurrence. In conclusion, when the absolute TA diameter is used as the primary criterion, smaller patients are at a higher risk for TR recurrence by having a proportionally larger TA at the time of repair. An individualized approach guided by patient's body size might be more appropriate to indicate FTR correction to adjust for the annuloplasty sizing method. (c) 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;207:21-27)

Automated summary

This study found that smaller patients are at a higher risk for tricuspid regurgitation (TR) recurrence when the absolute tricuspid annulus (TA) diameter is used as the primary criterion, as they tend to have a proportionally larger TA at the time of repair. An individualized approach guided by patient's body size might be more appropriate to indicate functional tricuspid regurgitation (FTR) correction and adjust for the annuloplasty sizing method.