Abstract 2065: Uncorrected Moderate Tricuspid Regurgitation Impacts Late Survival In Patients Undergoing Mitral Valve Replacement

Introduction: Little is known regarding the evolution and clinical impact of moderate tricuspid regurgitation (TR) in patients undergoing mitral valve replacement (MVR). This natural history study was conducted to determine: the predictors of TR progression and the impact of TR progression on late survival. Methods: Between 1989 and 2005, 352 patients (mean age 63.5 ± 12.4y) who underwent mitral valve replacement with contemporary prostheses (mechanical/bioprostheses = 70%/30%) were followed for the evaluation of their concomitant tricuspid regurgitation (mean grade 2.0+ at mitral surgery). These patients did not undergo concomitant tricuspid valve repair or replacement. Concomitant coronary artery bypass grafting (CABG) was performed in 34% of patients, with a mean of 2.1 grafts. Clinical and echocardiographic follow-up was 100% complete and averaged 5.7 ± 3.9 years. Parametric and semi-parametric techniques were used to determine predictors of outcomes. Results: Thirty-day mortality was 2.2%. Postoperative progression of TR was noted in 36% of patients. Multivariate predictors of TR progression included female gender (odds ratio (OR) 10.3; p=0.03) and right ventricular systolic pressures ≥ 50 mmHg preoperatively (OR 8.1; p=0.05). Atrial fibrillation, concomitant CABG, the degree of preoperative mitral regurgitation, and mitral prosthesis size were not predictive of TR progression. TR progression in patients whose TR was 2+ or more at the time of initial surgery was associated with significantly decreased late survival (hazard ratio 3.7; p=0.05). Conclusions: Based on these data, it appears that if TR is not surgically corrected at time of MVR, it may progressively worsen over time in a sizable proportion of patients. In patients with TR 2+ or more at the time of MVR, TR progression is associated with decreased late survival. It therefore appears indicated to repair TR of grade 2+ or more at the time of mitral surgery, particularly in female patients and in patients with right ventricular systolic pressures of 50 mmHg or more, which are both predictive of postoperative TR progression.

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P1585Long-term tricuspid regurgitation progression in patients undergoing combined mitral valve replacement surgery and tricuspid valve repair

European Heart Journal ◽

10.1093/eurheartj/ehy565.p1585 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

O Itzhaki Ben Zadok ◽

R Sharony ◽

M Vaturi ◽

Y Shapira ◽

T Bental ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Replacement Surgery ◽

Valve Replacement Surgery

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Factors for development of late significant tricuspid regurgitation after mitral valve replacement: the impact of subvalvular preservation

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2010.11.014 ◽

2011 ◽

Vol 39 (6) ◽

pp. 866-874 ◽

Cited By ~ 9

Author(s):

Rafael García Fuster ◽

Alejandro Vázquez ◽

Aritz García Peláez ◽

Elio Martín ◽

Sergio Cánovas ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Tricuspid Regurgitation ◽

The Impact

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Faculty Opinions recommendation of Outcomes of repeat mitral valve replacement in patients with prior mitral surgery: A benchmark for transcatheter approaches.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733267880.793564317 ◽

2019 ◽

Author(s):

Wendy Tsang

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Surgery

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RELATIONSHIP OF PREOPERATIVE RIGHT VENTRICULAR FUNCTION AND OUTCOME AFTER MITRAL VALVE REPLACEMENT SURGERY – A PROSPECTIVE OBSERVATIONAL STUDY

10.36106/4701425 ◽

2020 ◽

pp. 43-46

Author(s):

Debashis Karmokar ◽

Pinaki Majumdar ◽

Manjushree Ray ◽

Asim Kumar Kundu

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Ventricular Function ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Right Ventricular Function ◽

Low Cardiac Output Syndrome ◽

Replacement Surgery ◽

Grade 3 ◽

Valve Replacement Surgery

Objective:Right ventricular dysfunction constitutes a major risk factor for patients suffering from degenerative mitral valve disease. The objective of this study was to assess right ventricular function by echocardiography and to detect role of right ventricular functions in prediction of outcome following mitral valve replacement operation in patients with rheumatic heart disease involving mitral valve. Methods:Transthoracic 3D echocardiography was done in 52 patients posted for mitral valve replacement surgery. Right ventricular function was analyzed by measuring fractional area change (FAC) of right ventricle, tethering distance and, tricuspid annular plane systolic excursion (TAPSE). Tricuspid regurgitation was graded 0 to 4. Based on echocardiographic ndings of right ventricle, patients were allocated in two groups; Group A (normal right ventricular function) and Group B (poor right ventricular function). After surgery, incidence of complications such as; low cardiac output syndrome, refractory arrhythmia and, sepsis were compared in two group. Results: Incidence of postoperative complication such as low cardiac output syndrome and sepsis was signicantly more in patients with poor right ventricular function. Right ventricular variables, FAC <35%, TAPSE <17 mm and tethering distance > 8 mm are independent predictors of postoperative complications. Tricuspid valve was repaired in patients with grade 3 and 4 regurgitation. Therefore cardiopulmonary bypass time was signicantly more in patients with grade 3 and 4 TR (84.42±69.77 min) (p<0.01). Duration of intensive care support was also signicantly more in patients with poor right ventricular function (p<0.001) Conclusion: To predict possible complications and outcome following mitral valve replacement surgery, right ventricular functions should be thoroughly assessed by 3D echocardiography

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Levosimendan in Severe Right Ventricular Failure Following Mitral Valve Replacement

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2005.01.039 ◽

2006 ◽

Vol 20 (1) ◽

pp. 82-84 ◽

Cited By ~ 23

Author(s):

Rex Joseph Morais

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Right Ventricular Failure ◽

Ventricular Failure

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Retrospective Study of the Outcome of Mitral Valve Replacement with or without Tricuspid Valve Repair in Ain Shams University

QJM ◽

10.1093/qjmed/hcaa042.010 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A M A Elfeky ◽

M M A Fadala ◽

O A Abdelhameed ◽

R M R Khorshid

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Tricuspid Valve ◽

Mitral Valve Disease ◽

Valve Disease ◽

Morbidity And Mortality ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Number Of Patients

Abstract Background Rheumatic mitral valvular disease is more common than degenerative mitral valve disease. Mitral valve repair is not possible in large number of patients because of rheumatic cicatrized subvalvular mitral valve disease. The prosthetic mitral valve replacement is commonly performed in our center. Objective The aim of the study was to evaluate and assess the short outcome of Mitral Valve Replacement with or without Tricuspid Valve Repair. Patients and Methods This study was done in department of Cardiothoracic surgery, Faculty of Medicine at Ain Shams university, after approval of the local ethical committee from 2015 to 2016.The inclusion criteria includes All gender, All age, Primary Mitral valve replacement for severe Mitral valve disease of Rheumatic origin with or without Tricuspid Valve Repair and Primary Mitral valve replacement for severe Mitral valve disease of Degenerative origin with or without Tricuspid Valve Repair and the exclusion criteria includes concomitant coronary artery bypass graft surgery or other cardiac operations or infective endocarditis and Patients with chronic liver, kidney and parenchymal pulmonary disease. Results This study included one hundred and seventy- seven (177) patients; One hundred and thirty one (131) patients did Mitral Valve Replacement without Tricuspid valve Repair, Fourty six (46) patients did Mitral valve Replacement with Tricuspid valve Repair and the outcome was Mortality (3.9%), Reoperaion (5.08%), Stroke (0. 56%), Re-Intubation (1.13%) and Re-Admission to ICU (1.69%) Conclusion The Reoperation has a direct relation and effect on the Mortality,Prolonged bypass time independently predicts postoperative morbidity and mortality and Prolonged aortic cross-clamp time significantly correlates with major post-operative morbidity and mortality.

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