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• W3090720005 abstract "Central MessageTricuspid valve ring annuloplasty might not be the best intervention for functional tricuspid valve regurgitation. Understanding mechanisms of failure may lead to more durable repairs.See Article page 76. Tricuspid valve ring annuloplasty might not be the best intervention for functional tricuspid valve regurgitation. Understanding mechanisms of failure may lead to more durable repairs. See Article page 76. J. R. R. Tolkien's Lord of the Rings trilogy has as its centerpiece the character of Gollum and his obsession with the One Ring to Rule Them All. The tale, which is epic and has spawned numerous literary and philosophical debates, centers on the single ring that is all-powerful and designed to help Sauron gain control of Middle Earth. While there are numerous memorable characters and plots, Gollum calling the ring “my precious” is one of the most iconic aspects of the books and movies. In this issue of the Journal, Amedi and colleagues1Amedi A. Onohara D. Xu D. Sreerangathama Suresh K. Padala M. Hemodynamic outcomes after undersizing ring annuloplasty and focal suture annuloplasty for surgical repair of functional tricuspid regurgitation.J Thorac Cardiovasc Surg. 2022; 164: 76-87.e1Abstract Full Text Full Text PDF Scopus (3) Google Scholar describe their examination of 2 surgical techniques for tricuspid valve repair: tricuspid valve ring annuloplasty and Hetzer focal suture annuloplasty. They compare the 2 repair techniques using an ex vivo porcine heart functional model of tricuspid valve regurgitation (TR). Although both annuloplasty methods reduced functional TR, neither completely eliminated the TR, and the residual regurgitation was secondary to persistent leaflet tethering and decreased mobility.1Amedi A. Onohara D. Xu D. Sreerangathama Suresh K. Padala M. Hemodynamic outcomes after undersizing ring annuloplasty and focal suture annuloplasty for surgical repair of functional tricuspid regurgitation.J Thorac Cardiovasc Surg. 2022; 164: 76-87.e1Abstract Full Text Full Text PDF Scopus (3) Google Scholar Although the data are not from in vivo human measurements, they provide valuable information about 2 current tricuspid repair techniques and more importantly helps to explain the potential failure mechanisms of these repairs. These data may also help to explain the reported rates of recurrence of significant TR in 6% to 31% of patients following tricuspid ring annuloplasty.2McCarthy P.M. Sales V.L. Evolving indications for tricuspid valve surgery.Curr Treat Options Cardiovasc Med. 2010; 12: 587-597Crossref PubMed Scopus (23) Google Scholar Given that functional TR accounts for nearly 90% of all cases of TR,3Badano L.P. Muraru D. Enriquez-Sarano M. Assessment of functional tricuspid regurgitation.Eur Heart J. 2013; 34: 1875-1885Crossref PubMed Scopus (135) Google Scholar an understanding of the optimum method of repair is essential. Current guidelines for tricuspid valve repair are somewhat vague, with the only class 1 recommendation being for severe TR.4Nishimura R.A. Otto C.M. Bonow R.O. Carabello B.A. Erwin 3rd, J.P. Guyton R.A. et al.2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129: 2440-2492Crossref PubMed Scopus (1124) Google Scholar However, there is evidence demonstrating a lack of improvement of functional TR when left alone, and persistent significant TR is known to be associated with decreased quality of life and survival.5Taramasso M. Vanermen H. Maisano F. Guidotti A. La Canna G. Alfieri O. The growing clinical importance of secondary tricuspid regurgitation.J Am Coll Cardiol. 2012; 59: 703-710Crossref PubMed Scopus (215) Google Scholar Given the lack of clear direction, some believe that addressing the primary pathology (ie, mitral or aortic insufficiency) will lead to resolution of significant TR. Furthermore, the primary method of repair is ring annuloplasty alone given its ease of performance, with some advocating for use of a certain ring size for almost all patients.6Huffman L.C. Nelson J.S. Lehman A.N. Krajacic M.C. Bolling S.F. Identical tricuspid ring sizing in simultaneous functional tricuspid and mitral valve repair: a simple and effective strategy.J Thorac Cardiovasc Surg. 2014; 147: 611-614Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar This approach is quite different from the treatment of mitral valve regurgitation, for which there are numerous accepted options, although the most frequently used approaches are combinations of various techniques, such as chordal replacement or leaflet resection, with ring annuloplasty. Thus, models such as that described by Amedi and colleagues will help us understand why a particular method of repair may fail and potentially lead to more durable repair techniques. As we continue to grapple with functional TR, a better understanding of the impact of our repairs will be crucial to advances in therapy, and it will be beneficial to consider methods beyond simple ring annuloplasty. We do not live in Middle Earth, and despite our desire to follow Gollum's lead, in tricuspid valve repair, we need to stop searching for the One Ring to Rule Us All. Hemodynamic outcomes after undersizing ring annuloplasty and focal suture annuloplasty for surgical repair of functional tricuspid regurgitationThe Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 1PreviewSurgical annuloplasty for functional tricuspid regurgitation (FTR) is on the rise and can be performed in several ways with varied outcomes. In this study, we sought to compare the hemodynamic outcomes of tricuspid annuloplasty performed with a commercially available annuloplasty ring (tricuspid valve annuloplasty [TVA]) compared with focal suture annuloplasty (Hetzer) in an experimental FTR model. Full-Text PDF" @default.
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• W3090720005 title "Commentary: One ring to rule them all?" @default.
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