Autologous pericardial soft-ring annuloplasty may offer improved long-term control of rheumatic functional tricuspid regurgitation: a propensity-matched cohort study

Background To compare the long-term efficacy of autologous pericardial soft-ring annuloplasty (P-TVP) versus prosthetic ring annuloplasty (A-TVP) for functional tricuspid regurgitation (FTR) secondary to rheumatic heart disease (RHD). Methods A total of 251 consecutive RHD patients undergoing tricuspid annuloplasty from December 2013 to December 2023 were retrospectively analyzed. Among them, 139 underwent P-TVP and 112 received A-TVP. Propensity score matching (1:1) yielded 64 comparable pairs. Follow-up at 6,24,48 and 96 months assessed TR recurrence and right-heart remodeling. Multiple imputation was applied for partially missing follow-up data. Results Early outcomes at 6 and 24 months were similar between groups. However, recurrence of moderate TR was significantly lower in the P-TVP group at 48 and 96 months (both P < 0.05). Greater right-atrial reverse remodeling was observed in the P-TVP group at 48 months ( P < 0.05), while right-ventricular diameter remained comparable at 96 months ( P > 0.05). No increase in procedure-related complications was observed in the P-TVP group. Conclusions In this hypothesis-generating study, autologous pericardial soft-ring annuloplasty was associated with more favorable long-term TR control and right atrial reverse remodeling compared with prosthetic ring annuloplasty, despite similar early outcomes. These findings suggest a potential advantage of flexible biological annuloplasty in selected RHD patients, but should be interpreted with caution due to the modest sample size, incomplete follow-up, and retrospective design. Prospective multicenter studies are required to confirm these observations.