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This study compares the medium-term results of De Vega, modified De Vega, and ring annuloplasty techniques for the correction of tricuspid insufficiency and investigates the risk factors for recurrent grades 3 and 4 tricuspid insufficiency after repair. In our clinic, 93 patients with functional tricuspid insufficiency underwent surgical tricuspid repair from May 2007 through October 2010. The study was retrospective, and all the data pertaining to the patients were retrieved from hospital records. Functional capacity, recurrent tricuspid insufficiency, and risk factors aggravating the insufficiency were analyzed for each patient. In the medium term (25.4 ± 10.3 mo), the rates of grades 3 and 4 tricuspid insufficiency in the De Vega, modified De Vega, and ring annuloplasty groups were 31%, 23.1%, and 6.1%, respectively. Logistic regression analysis revealed that chronic obstructive pulmonary disease, left ventricular dysfunction (ejection fraction, < 0.50), pulmonary artery pressure ≥60 mmHg, and the De Vega annuloplasty technique were risk factors for medium-term recurrent grades 3 and 4 tricuspid insufficiency. Medium-term survival was 90.6% for the De Vega group, 96.3% for the modified De Vega group, and 97.1% for the ring annuloplasty group. Ring annuloplasty provided the best relief from recurrent tricuspid insufficiency when compared with DeVega annuloplasty. Modified De Vega annuloplasty might be a suitable alternative to ring annuloplasty when rings are not available.

We retrospectively investigated preoperative and postoperative characteristics in order to determine factors that affected hospital death in patients who underwent 3 or 4 separate cardiac valvular surgeries. The hospital records of 53 such patients who were operated upon from 1985 through 2006 were obtained. The patients were divided into 2 groups according to whether their initial operation was a closed mitral commissurotomy (group C, n = 33) or open-heart surgery with cardiopulmonary bypass (group O, n = 20). In group C, all patients who had initially undergone 1 or 2 closed mitral commissurotomy procedures underwent subsequent reoperations that entailed median sternotomy and cardiopulmonary bypass. Sternotomy and cardiopulmonary bypass had been used in valvular operations of all group O patients. The total early mortality rate was 11.3% (6 of 53 patients). Multivariate analysis revealed that longer aortic cross-clamp times and double valve replacement at last operation significantly increased the risk of death. Herein, we discuss our conclusion that 3rd or 4th cardiac valvular operations incurred acceptable early postoperative mortality rates.

Background and Aim of the Study: Small valve size and patient-prosthesis mismatch (PPM) generate high postoperative transvalvular gradients and may decrease both early and long-term survival. The study aim was to evaluate whether mismatch affected early mortality after aortic valve replacement (AVR) for isolated aortic stenosis (AS)., Methods: A total of 701 patients (437 males, 264 females; mean age 53.3 +/- 15.1 years; range: 14-84 years) with pure AS underwent AVR at the authors' institution between 1985 and 2005. The majority of patients (92%) received a mechanical valve. PPM was considered severe if the indexed effective orifice area was < or =0.65 cm2/m2, and moderate if > 0.65 but < or = 0.85 cm2/m2., Results: Moderate-severe PPM was present in 47% of patients, and severe PPM in 13%. The early mortality was 5.4% (n=38). Multivariate analysis revealed age > or = 70 years (p < 0.001), female gender (p = 0.04) and severe PPM (p = 0.003) as independent predictors of early mortality. Moderate mismatch was not a predictor of early mortality on both univariate and multivariate analysis. Left ventricular dysfunction (ejection fraction < or = 40%) was a risk factor for early mortality only in patients with severe PPM., Conclusion: Patient-prosthesis mismatch should be prevented in patients undergoing AVR for isolated AS, especially in those with left ventricular dysfunction.