Long-term results (up to 14 years) of the clover technique for the treatment of complex tricuspid valve regurgitation

Michele De Bonis, Elisabetta Lapenna, Stefania Di Sanzo, Benedetto Del Forno, Federico Pappalardo, Alessandro Castiglioni, Luca Vicentini, Alberto Pozzoli, Ilaria Giambuzzi, Azeem Latib, Davide Schiavi, Giovanni La Canna, Ottavio Alfieria

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


OBJECTIVES: To report the long-term results of the clover technique for the treatment of complex forms of tricuspid regurgitation (TR). METHODS: Ninety-six consecutive patients (mean age 60 ± 16.4, left ventricular ejection fraction 58 ± 8.8%) with severe or moderatelysevere TR due to important leaflets prolapse/flail (81 patients), tethering (13 patients) or mixed (2 patients) lesions underwent clover repair combined with annuloplasty. The aetiology of TR was degenerative in 74 cases (77.1%), post-traumatic in 9 (9.4%) and secondary to dilated cardiomyopathy in 13 (13.5%). All patients but 3 (96.8%) underwent ring (59 patients, 61.5%) or suture (34 patients, 35.4%) annuloplasty. Concomitant procedures (mainly mitral surgery) were performed in 82 patients (85.4%). RESULTS: Hospital mortality was 7.2%. At hospital discharge 92 (95.8%) patients had no or mild TR. Follow-up was 98% complete (median 9 years, interquartile range 5.1; 10.9). At 12 years the overall survival was 71.6 ± 7.22% and the cumulative incidence function of cardiac death with non-cardiac death as competing risk 16 ± 4.1% [95% confidence interval (95% CI) 9.5-25.7]. At 12 years the cumulative incidence function of TR ≥3+ and TR ≥2+ with death as competing risk were 1.2 ± 1.2% (95% CI 0.1-5.8) and 28 ± 7.7% (95% CI 14.3-43.5), respectively. Preoperative left ventricular ejection fraction (hazard ratio 0.9, CI 0.9-1, P = 0.05) and previous cardiac surgery (hazard ratio 2.7, 95% CI 1-7.1, P = 0.03) were predictors of recurrent TR ≤2+ at univariable but not at multivariable analysis. CONCLUSIONS: Complex forms of TR due to severe prolapse or tethering of the leaflets can be effectively treated with the clover technique with very satisfactory long-term results and extremely low recurrence of severe TR.

Original languageEnglish (US)
Pages (from-to)125-130
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number1
StatePublished - Jul 1 2017
Externally publishedYes


  • Tricuspid prolapse
  • Tricuspid regurgitation
  • Valve repair

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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