Surgical management of secondary tricuspid valve regurgitation: Annulus, commissure, or leaflet procedure? Jose L. Navia, MD, Edward R. Nowicki, MD,

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Surgical management of secondary tricuspid valve regurgitation: Annulus, commissure, or leaflet procedure? Jose L. Navia, MD, Edward R. Nowicki, MD, MS, Eugene H. Blackstone, MD, Nicolas A. Brozzi, MD, Daniel E. Nento, MD, Fernando A. Atik, MD, Jeevanantham Rajeswaran, MSc, A. Marc Gillinov, MD, Lars G. Svensson, MD, PhD, Bruce W. Lytle, MD The Journal of Thoracic and Cardiovascular Surgery Volume 139, Issue 6, Pages 1473-1482.e5 (June 2010) DOI: 10.1016/j.jtcvs.2010.02.046 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Tricuspid valve procedures across time. C-E, Carpentier–Edwards rigid ring; MC3, Edwards MC3 Annuloplasty System 3-dimensional ring. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Overall temporal trend of postoperative tricuspid regurgitation (TR) grades after tricuspid valve repair. Solid lines represent parametric estimates of percentage of patients (mean effect) in each TR grade. Symbols represent data grouped without regard to repeated measurements within time frame to provide a crude verification of model fit. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Prevalence of postoperative tricuspid regurgitation (TR) 3+/4+ for each procedure group. The parametric estimates are based on separate decomposition models for each procedure group. Solid lines represent unadjusted estimates of TR grades 3+ or 4+ for each procedure group. Symbols represent data grouped without regard to repeated measurements within a time frame to provide a crude verification of model fit. C-E, Carpentier–Edwards rigid ring; MC3, Edwards MC3 Anuloplasty System 3-dimensional ring. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Freedom from reoperation (Kaplan–Meier estimates) according to tricuspid valve (TV) procedure. Vertical bars represent 68% confidence limits (equivalent to ±1 standard error). The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Survival after tricuspid valve repair according to procedure performed. Format is as in Figure 4. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Number of patients with echocardiograms available at and beyond various time points, and number of echocardiograms available for analysis. Black bars = patients; gray bars = echocardiograms. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Freedom from reoperation related to tricuspid valve Freedom from reoperation related to tricuspid valve. Each symbol represents a reoperation, vertical bars are 68% confidence limits (equivalent to ±1 standard error), and solid line enclosed within dashed 68% confidence limits is parametric estimate. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Overall survival after tricuspid valve repair Overall survival after tricuspid valve repair. Format is as in Appendix E4 The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Freedom from permanent pacemakers (PPM) after tricuspid valve repair according to procedure performed. Format is as in Figure 4. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Temporal trend of postoperative right ventricular systolic pressure (RVSP) according to procedure group. Format is as in Figure 2. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Temporal trend of postoperative New York Heart Association (NYHA) functional class according to procedure performed. Format is as in Figure 2. A, NYHA class I. B, NYHA class III/IV. The Journal of Thoracic and Cardiovascular Surgery 2010 139, 1473-1482.e5DOI: (10.1016/j.jtcvs.2010.02.046) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions