Tricuspid annulus diameter does not predict the development of tricuspid regurgitation after mitral valve repair for mitral regurgitation due to degenerative diseases

Abstract Background Recurrent MR has been associated with poor prognosis after transcatheter mitral valve repair (TMVR) with the MitraClip system. However, little is known about risk factors and etiology of recurrent mitral regurgitation (MR) after transcatheter edge-to-edge mitral repair with the MitraClip system. Methods Among consecutive patients who underwent MitraClip for MR from January 2011 to March 2019, we identified 240 patients who had MR ≤2+ at discharge and follow-up echocardiography within three years after the procedure. Recurrent MR was defined as MR ≥3+ during the follow-up period. To investigate the risk factors for recurrent MR, we conducted a Cox proportional hazard model. Results During the follow-up period (median 491 days), 38 patients (15.8%) had recurrent MR (≥3+). The most frequent etiology of recurrent MR was degenerative (n=20, 52.6%), including single leaflet detachment (n=2, 5.3%), loss of leaflet insertion (n=11, 28.9%), and leaflet tear or prolapse (n=7, 18.4%), followed by functional MR (n=18, 47.4%). The risk factors for recurrent MR were greater LV end-diastolic volume (adjusted-HR 1.01, 95% CI 1.00–1.02, p=0.03), higher LV ejection fraction (LVEF) (adjusted-HR 1.05, 95% CI 1.01–1.08, p=0.005), and moderate MR upon discharge (adjusted-HR 2.98, 95% CI 1.50–5.95, p=0.002).After stratification according to the etiology of MR, the association of LVEF was more pronounced in patients with degenerative MR (adjusted-HR 1.07, 95% CI 1.02–1.12, p=0.003), while the association of moderate MR upon discharge was more pronounced in patients with functional MR (adjusted-HR 5.02, 95% CI 1.95–12.8, p<0.001). Furthermore, patients with recurrent MR had an increased antero-posterior annulus diameter regardless of the baseline etiology of the MR. Conclusions Greater LV volume, higher LVEF, and moderate MR at discharge were associated with an increased risk of recurrent MR after the MitraClip procedure. A significant increase of the annulus diameter was observed regardless of the baseline etiology of the MR. Etiology of recurrent MR Funding Acknowledgement Type of funding source: None

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Tricuspid regurgitation is uncommon after mitral valve repair for degenerative diseases

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2016.12.046 ◽

2017 ◽

Vol 154 (1) ◽

pp. 110-122.e1 ◽

Cited By ~ 27

Author(s):

Tirone E. David ◽

Carolyn M. David ◽

Chun-Po S. Fan ◽

Cedric Manlhiot

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Tricuspid Regurgitation ◽

Degenerative Diseases ◽

Valve Repair

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TRICUSPID ANNULOPLASTY FOR FUNCTIONAL TRICUSPID REGURGITATION IN PATIENTS UNDERGOING MITRAL VALVE REPAIR FOR SEVERE MITRAL REGURGITATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)62020-4 ◽

2015 ◽

Vol 65 (10) ◽

pp. A2020

Author(s):

Takeshi Kitai ◽

Yukikatsu Okada ◽

Takafumi Yamane ◽

Kitae Kim ◽

Shuichiro Kaji ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Tricuspid Regurgitation ◽

Severe Mitral Regurgitation ◽

Valve Repair ◽

Tricuspid Annuloplasty ◽

Functional Tricuspid Regurgitation

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Progression of Tricuspid Regurgitation After Repaired Functional Ischemic Mitral Regurgitation

Circulation ◽

10.1161/circulationaha.104.524421 ◽

2005 ◽

Vol 112 (9_supplement) ◽

Cited By ~ 2

Author(s):

Akira Matsunaga ◽

Carlos M. G. Duran

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Tricuspid Regurgitation ◽

De Novo ◽

Ischemic Mitral Regurgitation ◽

Tricuspid Annulus ◽

Valve Repair ◽

Functional Tricuspid Regurgitation ◽

Cardiac Lesions

Background— Despite correction of left-sided cardiac lesions, associated functional tricuspid regurgitation (TR) that was surgically ignored can persist. It can also appear de novo. The aim of this study was to analyze TR in a group of patients who underwent successful revascularization and mitral valve repair (MVRep) for functional ischemic mitral regurgitation (MR). Methods and Results— Among 124 consecutive patients with MVRep, 70 left the operating room with MR ≤1+ and had a preoperative and follow-up transthoracic echocardiogra. Moderate or greater MR or TR was considered significant. Twenty-one patients (30%) had TR before surgery, and only 9 had TR repaired. The postoperative incidence of residual TR was not significantly different whether the tricuspid valve had been repaired (4 of 9 [44%]) or surgically ignored (8 of 12 [67%]). At last follow-up, 34 patients (49%) had significant TR. The incidence of TR increased from 25% at <1 year to 53% between 1 and 3 years and 74% at >3 years. Absence or presence of recurrent MR did not significantly affect TR (14 of 22 [64%] with MR versus 20 of 48 [42%] with no MR). Preoperative and postoperative tricuspid annulus size in patients with late TR was significantly larger than in patients without TR. Conclusions— Functional TR is frequently associated with functional ischemic MR. After MVRep, close to 50% of patients have TR. The incidence of postoperative TR increases with time. Preoperative tricuspid annulus dilation might be a predictor of late TR.

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