Early Postoperative Outcomes of De Vega Versus Ring Tricuspid Annuloplasty in Patients Undergoing Mitral Valve Replacement

Abstract

Background: Patients having mitral valve replacement (MVR) frequently have functional tricuspid regurgitation (TR), which is linked to poor postoperative results if treatment is not received. The relative effectiveness and safety of two popular surgical methods for tricuspid annuloplasty, De Vega semicircular suture annuloplasty and prosthetic ring annuloplasty, are still being compared.

Objectives: This study aimed to compare the early clinical and echocardiographic outcomes of De Vega suture annuloplasty versus prosthetic ring annuloplasty in patients with moderate-to-severe functional TR undergoing concomitant MVR.

Methods: A prospective comparative cohort study was conducted at Shebein Elkom Teaching Hospital and the National Heart Institute. Sixty adult patients with moderate-to-severe functional TR scheduled for MVR were enrolled and equally divided into two groups: Group A (De Vega group, n = 30) underwent De Vega semicircular suture annuloplasty, and Group B (Ring group, n = 30) underwent prosthetic rigid or semi-rigid ring annuloplasty.

Results: Intraoperative characteristics — including CPB time (p = 0.742), aortic cross-clamp time (71.8 ± 10.4 vs. 68.3 ± 9.7 min; p = 0.186), and total procedure time (p = 0.553) — were comparable between groups. Both groups demonstrated significant improvements in EF (p = 0.003) and significant reductions in PAP postoperatively, with no statistically significant difference between groups (p = 0.248 and p = 0.368, respectively). Postoperative TR severity distribution was similar between groups (mild TR: 56.7% vs. 60.0%; p = 0.807). ICU stay was comparable (4.8 ± 1.7 vs. 4.1 ± 1.2 days; p = 0.085). No statistically significant differences were observed in postoperative complications, including prolonged intubation, tracheostomy, IABP use, ECMO requirement, or need for dialysis. Thirty-day mortality was 6.7% in the De Vega group and 10.0% in the ring group (p = 1.0).

Conclusion: Both De Vega suture annuloplasty and prosthetic ring annuloplasty yielded comparable early postoperative outcomes in patients with functional TR undergoing MVR, including equivalent improvements in EF and PAP, similar TR severity grades, and comparable complication and mortality rates. While ring annuloplasty demonstrated a numerical trend toward greater hemodynamic improvement, the differences did not reach statistical significance in this early follow-up period. Long-term studies are warranted to determine whether differences in TR recurrence and durability emerge between the two techniques over time.