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Comparison of Kay's and de Vega's annuloplasty in surgical treatment of tricuspid incompetence. Clinical and haemodynamic results in 62 patients.

This paper compares the late results of Kay's and de Vega's annuloplasty in the management of tricuspid incompetence. The operations were done in 62 consecutive patients during the nine-year period 1969-77 and included simultaneous correction of acquired valvular lesions (58/62) and congenital malformations (4/62). Kay's bicuspidalization and de Vega's annular plication were performed in 27 vs. 35 patients and these two groups were similar in the most important respects. Tricuspid regurgitation was recognized in 44/62 patients (71%) before surgery, whereas in 18/62 patients (29%) it was diagnosed at intra-operative exploration. The majority of cases (84%) were functional in origin and 16% had anatomical lesions causing or contributing to significant incompetence. Most of the patients (90%) belonged to functional class III or IV (N.Y.H.A.) before operation. The type of tricuspid repair had no bearing on early (11% vs. 14%) and late mortality (5.8%/year vs. 5.0%/year). Re-evaluation in 50 patients showed that Kay's bicuspidalization and de Vega's annular plication gave similar and good late result in about 70% of the cases. The risk of over-correction was low in that only 1/30 cardiac catheterization revealed signs of mild tricuspid stenosis. Recurrent or residual tricuspid incompetence is probably related to the severity of the individual cases. Some of these failures were evident already on the patient's discharge from hospital but, unfortunately, not predictable from the pre- or intra-operative evaluations.