Surgical management of tricuspid regurgitation: a new algorithm to minimise recurrent tricuspid regurgitation Rodríguez Torres, Diego Torres Quintero, Lucía Segura Rodríguez, Diego Garrido Jiménez, José Manuel Esteban Molina, María Gomera Martínez, Francisco Moreno Escobar, Eduardo García Orta, Rocío Introduction Recurrent tricuspid regurgitation (TR) is frequently observed after cardiac surgery; however, the correct approach remains controversial. We developed an algorithm for action on the tricuspid valve (TV) and conducted a 1-year follow-up study. The aim was to assess the efficacy of the algorithm to minimise residual TR after TV surgery. The hypothesis was that the TR rate at 1 year would be reduced by selecting the surgical approach in accordance with a set of preoperative clinical and echocardiographic variables. Methods A prospective, observational, single-centre study was performed in 76 consecutive patients with TV involvement. A protocol was designed for their inclusion, and data on their clinical and echocardiographic characteristics were gathered at 3 months and 1-year postsurgery. The treatment of patients depended on the degree of TR. Surgery was performed in all patients with severe or moderate-to- severe TR and in those with mild or moderate TR alongside the presence of certain clinical or echocardiographic factors. They underwent annuloplasty or extended valve repair when the TV was distorted. If repair techniques were not feasible, a prosthesis was implanted. Residual TR rates were compared with published reports, and predictors of early/late mortality and residual TR were evaluated. Results TR was functional in 69.9% of patients. Rigid ring annuloplasty was performed in 35.7% of patients, De Vega annuloplasty in 27.1%, extended repair in 11.4% and prosthetic replacement in 25.7%. TR was moderate or worse in 8.19% of patients (severe in 3.27%) at 1 year postintervention. No clinical, surgical or epidemiological variables were significantly associated with residual TR persistence, although annulus diameter showed a close-to- significant association. Total mortality was 12.85% for all causes and 10% for cardiovascular causes. In multivariate analysis, left ventricular ejection fraction was related to both early and late mortality. Conclusions Severe residual TR was significantly less frequent than reported in other series, being observed in less than 4% of patients at 1-year postsurgery. 2022-09-08T09:02:04Z 2022-09-08T09:02:04Z 2022-07-25 info:eu-repo/semantics/article Rodriguez Torres D... [et al.]. Surgical management of tricuspid regurgitation: a new algorithm to minimise recurrent tricuspid regurgitation. Open Heart 2022;9:e002011. doi:[10.1136/openhrt-2022-002011] http://hdl.handle.net/10481/76581 10.1136/openhrt-2022-002011 eng http://creativecommons.org/licenses/by-nc/4.0/ info:eu-repo/semantics/openAccess Atribución-NoComercial 4.0 Internacional BMJ