Long-term echocardiographic follow-up of untreated 2+ functional tricuspid regurgitation in patients undergoing mitral valve surgery

Aim: We investigated the incidence and predictors of tricuspid regurgitation (TR) development long after left-sided valve surgery in patients without significant preoperative TR. Methods: Of 615 patients who underwent surgery for left-sided valve disease between 1992 and 1995, 335 patients without preoperative TR who completed at least 5 years of clinical and echocardiographic follow-up were enrolled. Late significant TR development was assessed by echocardiography with a mean follow-up duration of 11.6 ± 2.1 years. Results: Significant late TR was found in 90 patients (26.9%). Patients with late TR showed; an advanced age, a higher prevalence of atrial fibrillation and prior valve surgery, and a greater left atrial dimension. In addition, late TR was more frequent in patients with mitral valve surgery. Systolic pulmonary artery pressure and mean right atrial pressure were not different between the groups. Multivariate analysis showed that the preoperative atrial fibrillation (OR 5.37; 95% CI. 2.71–10.65; p<0.001) was the only independent factor of late TR development. Patients that developed late TR had a lower event-free survival rate than those that did not (p=0.03). Conclusion: The development of significant TR long after left-sided valve surgery is not uncommon and is associated with a poor prognosis. The preoperative atrial fibrillation is an independent predictor of the late TR. Main Clinical and Echocardiographic Characteristics According to the Presence of Significant Late TR

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Impact of tricuspid ring annuloplasty on functional tricuspid regurgitation after mitral valve surgery

Menoufia Medical Journal ◽

10.4103/mmj.mmj_621_17 ◽

2019 ◽

Vol 32 (2) ◽

pp. 587

Author(s):

HeshamH Ahmed ◽

AhmedL Dokhan ◽

MohammedE Abdelraof ◽

AmrM Allama ◽

ShahzadG Raja

Keyword(s):

Mitral Valve ◽

Tricuspid Regurgitation ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Functional Tricuspid Regurgitation ◽

Ring Annuloplasty

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Evolution of Tricuspid Regurgitation after Mitral Valve Surgery for Patients with Moderate-or-Less Functional Tricuspid Regurgitation

The Heart Surgery Forum ◽

10.1532/hsf98.20111003 ◽

2012 ◽

Vol 15 (3) ◽

pp. 121 ◽

Cited By ~ 8

Author(s):

Kai-hu Shi ◽

Hai-yang Xuan ◽

Fei Zhang ◽

Sheng-song Xu ◽

Jun-xu Wu ◽

...

Keyword(s):

Multivariate Analysis ◽

Mitral Valve ◽

Postoperative Period ◽

Tricuspid Regurgitation ◽

Mitral Valve Surgery ◽

Tricuspid Annulus ◽

Lower Survival ◽

Functional Tricuspid Regurgitation ◽

The Impact

Objectives: The purpose of this study was to evaluate the impact of moderate-or-less functional tricuspid regurgitation (TR) treatment on the clinical outcome of patients with mitral valve (MV) surgery.Methods: From October 2001 to January 2005, 167 patients in our hospital with MV surgery and without organic tricuspid valve (TV) disease or pulmonary hypertension (PH) showed moderate-or-less functional TR preoperatively, and 41.9% of these patients were treated with TR (group T), compared with 58.1% untreated with TR (group no-T). According to tricuspid annulus dimension (TAD)/body surface area (BSA), these 167 patients were further divided into another 2 groups (A and B): group A (70 patients) represented TAD/BSA ? 21 mm/m2 with 32 patients from group T and 38 from group no-T, and group B (97 patients) represented TAD/BSA > 21 mm/m2 with 38 patients from group T and 59 patients from group no-T. There was no statistical difference in preoperative and operative variables between the 2 groups. Meanwhile, among the 167 patients with MV surgery, 157 patients were replaced with MV and 10 patients were repaired with MV, and De Vega technique was constantly used for TR treatment. All the results were estimated by multivariate analysis.Results: The median follow-up time was 63 months (25th and 75th percentiles are 53 and 94 months, respectively); 30-day mortality was 3% (1.4% in group T versus 4.1% in group no-T; P = .31). Adjusted 5-year survival was 70.7% (66.6%-80.4%) with 85.3% (83.0%-93.4%) in group T and 64.7% (33.7%-58.3%) in group no-T, P = .001. Among the 70 patients with TAD/BSA ? 21 mm/m2, patients who received treatment of moderate-or-less TR and those who did not showed similar secondary TR grade at postoperative period (0.5 � 0.6 in group T versus 0.9 � 0.9 in group no-T; P = .2) and follow-up (1.3 � 1.1 in group T versus 1.8 � 1.1 in group no-T; P = .06). In subgroup B (TAD/BSA > 21 mm/m2), patients who received tricuspid valvoplasty manifested more significantly improved outcome than patients without functional TR at postoperative period (0.8 � 0.8 in group T versus 1.6 � 1.3 in group no-T; P = .03) and follow-up (2.0 � 1.2 in group T versus 3.0 � 1.1 in group no-T; P = .005). The multivariate analysis identified TAD/BSA > 21 mm/m2 and preoperative atrial fibrillation (AF) as the risk factors for lower survival at follow-up period.Conclusions: Patients with MV surgery have better midterm outcome when they receive either more aggressive and effective surgical treatment for functional TR or moderate-or-less TR preoperatively. Indexed TAD (TAD/BSA > 21 mm/m2) is a more reliable surgical guideline for the treatment of TR. Preoperative tricuspid annulus dilation and AF might be predictors of late lower survival.

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Percutaneous mitral balloon valvuloplasty. Single versus Inoue balloon. long term follow-up

European Heart Journal ◽

10.1093/ehjci/ehaa946.2647 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

I Aragao ◽

E.C.S Peixoto ◽

R.T.S Peixoto ◽

I.L.P.B Dos Anjos ◽

...

Keyword(s):

Risk Factors ◽

Mitral Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Balloon Valvuloplasty ◽

Long Term Follow Up ◽

Independent Risk Factors ◽

Inoue Balloon

Abstract Introduction The single balloon (SB) is the less expensive technique to perform mitral balloon valvuloplasty (MBV). Objectives: This study aimed to demonstrate that MBV with the Balt single (BSB) and Inoue ballon, the wordwire accepted technique, had similar outcome and long-term follow-up (FU). Methods From 1987 to 2013, 526 procedures were performed, being 312 with a FU, 56 (17,9%) with Inoue balloon (IB) and 256 (82,1%) with BSB. The mean FU 156±144 months, p<0.0001. Univariate analysis (UA) and multivariate Cox analysis (MCA) to determine independent predict variables of survival and event free survival (EFS) of death, cardiac surgery and new MBV, in both techniques groups. Results In IB and BSB groups there were, respectively: female 42 (75.0%) and 222 (86.7%); mean age 37.3±10.0 (19 to 63) and 38.0±12.6 (13 to 83) years, p=0.7138; sinus rhythm 51 (91.1%) and 215 (84.0%), p=0.1754; echo score (ES) 7.6±1.3 (5 to 10) and 7.2±1.5 (4 to 14) points, p=0.0528; echo mitral valve area (MVA) pre-MBV 0.96±0.18 and 0.93±0.21 cm2, p=0.2265; post-MBV mean MVA (Gorlin) were 2.00±0.52 and 2.02±0.37 cm2, p=0.9554; MBV dilatation área 6,09±0,27 and 7,02±0,30, p<0,0001. At the end of the FU, there were in IB and BSB groups, respectively: echo MVA 1.71±0.41 and 1.54±0.51 cm2, p=0.0552; new severe mitral regurgitation in 5 (8.9%) and 17 (6.6%) patients, p=0.5633; new MBV in 1 (1.8%) and 13 (5.1%), p=0.4779; mitral valve surgery in 3 (5.4%) and 27 (10.4%), p=0.3456; deaths 2 (3.6%) and 11 (4.3%), p=1.000; cardiac deaths 1 (1.8%) and 9 (3.5%), p=1.000; ME 5 (8.9%) and 46 (18.0%), p=0.1449. In UA and MCA the BSB or IB technique do not predict survival or EFS. The independent risk factors to survival were: age <50 years (p=0.016, HR=0.233, 95% IC 0.071- 0.764), ES ≤8 (p<0.001, HR=0.105, 95% IC 0.34–0.327), MBV dilatation area (p<0.001, HR 16.838, 95% IC 3.353–84.580) and no mitral valve surgery in the FU (p=0.001, HR0.152, 95% IC 0.050–0.459). Independent risk factors to EFS: no prior commissurotomy (p=0.012, HR=0.390, 95% IC 0.187–0.813) and post-MBV MVA ≥1.50 cm2 (p=0.001, HR=7.969, 95% IC 3.413–18.608). Conclusion In 25 years, survival and EFS were similar in BSB and IB technique. Independent predictors of surviva: age <50 years, ES≤8 points, MBV dilatation area >7 mm2 and no mitral valve surgery in the FU. Independent predictors of EFS: no prior commissurotomy and post-MBV MVA≥1.50 cm2 Funding Acknowledgement Type of funding source: None

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Early treatment of functional tricuspid regurgitation at the time of mitral valve surgery: an increased risk or an additional benefit?

Vessel Plus ◽

10.20517/2574-1209.2017.35 ◽

2018 ◽

Vol 2 (3) ◽

pp. 4

Author(s):

Paolo Nardi ◽

Calogera Pisano ◽

Antonio Pellegrino ◽

Fabio Bertoldo ◽

Sabrina Ferrante ◽

...

Keyword(s):

Mitral Valve ◽

Tricuspid Regurgitation ◽

Early Treatment ◽

Mitral Valve Surgery ◽

Additional Benefit ◽

Valve Surgery ◽

Functional Tricuspid Regurgitation ◽

Increased Risk

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Surgical Repair versus Conservative Treatment for Moderate Functional Tricuspid Regurgitation in Concomitant with Mitral Valve Surgery

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v2i2.123 ◽

2020 ◽

Vol 2 (2) ◽

pp. 70-75

Author(s):

Moataz Rezk ◽

Shimaa Moustafa ◽

Nora Singab ◽

Ashraf Elnahas

Keyword(s):

Mitral Valve ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Surgical Repair ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Functional Tricuspid Regurgitation ◽

Group A ◽

Group B ◽

Valve Lesion

Background: Management of moderate functional tricuspid regurgitation (FTR) secondary to left-sided valve lesion is controversial. The objective of this study was to compare the short-term results of surgical repair versus conservative treatment for moderate functional tricuspid regurgitation in concomitant with mitral valve surgery. Methods: Our study included 60 patients with mitral valve lesion and moderate functional tricuspid regurgitation. Patients were divided into 2 groups; group A included 30 patients whose tricuspid valve disease were managed conservatively, and group B included 30 patients who had tricuspid valve band annuloplasty. Results: Preoperative clinical and echocardiographic data were comparable between groups. There was no difference regarding mechanical ventilation time (6 .13 ± 3.02 vs. 7.01 ± 4.14 hours; p= 0.291), or intensive care unit stay (51.42 ± 12.1 vs. 52.31 ± 15.32 hours; p=0.614) in group A and B respectively. There was a significant improvement in the degree of tricuspid valve regurgitation in group B early postoperative (moderate tricuspid regurgitation reported in 22 (73.3%) vs. 4 (13.3%); p<0.001) and at 3 months (moderate tricuspid regurgitation 11 (36.7%) vs. 2 (6.7%); p<0.001) and 6 months follow up (moderate tricuspid regurgitation 10 (30%) vs. 2 (6.7%); p<0.001) in group A and B respectively. After 6-months, 20 (66.7%) patients in group A had dyspnea grade I compared to 26 (86.7%) patients in group B; p=0.021. Conclusion: Although the correction of the left-sided lesion improved the degree of TR in some patients, concomitant repair of the tricuspid valve could produce better improvement in the clinical outcome when compared to the conservative approach.

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