Efficacy of singular and composite annular repositioning and subvalvular surgical techniques to treat functional tricuspid regurgitation due to leaflet tethering: Early results of a feasibility study

Abstract OBJECTIVES The goal of this study was to evaluate the outcomes of patients with subvalvular procedures for functional tricuspid regurgitation (TR) with severe leaflet tethering. METHODS Of 175 patients who had tricuspid valve surgery between June 2016 and June 2021, a total of 17 patients with functional TR with a preoperative tethering height ≥8 mm underwent subvalvular procedures (annular repositioning [An-Rep]) to reduce septal leaflet tethering, papillary muscle relocation to reduce anterior leaflet tethering, and/or papillary muscle bundling [PMB] to reduce anterior and posterior leaflet tethering along with ring annuloplasty at our institution. A single subvalvular procedure was performed in 9 patients (An-Rep in 5 patients, PMB in 4 patients; group S), and a combination of subvalvular procedures was performed in 8 patients (An-Rep and papillary muscle relocation in 5 patients, An-Rep and PMB in 3 patients; group C). RESULTS Predischarge TR grades and tethering height were significantly improved (3.2 ± 1.3–1.0 ± 0.5, p = 0.001; 9.9 ± 2.5 mm–5.5 ± 2.8 mm, p < 0.001, respectively). An-Rep and PMB significantly reduced the postoperative closing angles of the septal and anterior leaflets, respectively. During the 20.4 ± 19.5-month follow-up period, the rates of freedom from death and moderate TR at 2 years were 41.7% in group S, and 71.4% in group C (p = 0.39), respectively. In group C, TR recurrence was not observed at 2 years postoperatively. CONCLUSIONS Subvalvular procedures were effective in reducing the predischarge TR grades and tethering height. The combination of subvalvular procedures might be a durable strategy to prevent recurrent TR. Tricuspid annuloplasty (TAP) is a common and useful procedure for treating tricuspid regurgitation (TR) with annular dilatation.