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

2012 ◽  
Vol 15 (3) ◽  
pp. 121 ◽  
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

<p><b>Objectives:</b> 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.</p><p><b>Methods:</b> 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.</p><p>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; <i>P</i> = .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, <i>P</i> = .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; <i>P</i> = .2) and follow-up (1.3 � 1.1 in group T versus 1.8 � 1.1 in group no-T; <i>P</i> = .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; <i>P</i> = .03) and follow-up (2.0 � 1.2 in group T versus 3.0 � 1.1 in group no-T; <i>P</i> = .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.</p><p>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.</p>

scholarly journals Progression of Tricuspid Regurgitation After Repaired Functional Ischemic Mitral Regurgitation

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
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.

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

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

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

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.

scholarly journals Role of the tricuspid annulus in functional tricuspid regurgitation development after early isolated mitral valve surgery: is it an old story?

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
V Volpato ◽  
V Mantegazza ◽  
G Tamborini ◽  
P Gripari ◽  
M Muratori ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Cardiac Events ◽  
Basal Diameter ◽  
Functional Tricuspid Regurgitation ◽  
Group 2 ◽  
Rv Function ◽  
Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background. Functional Tricuspid Regurgitation (FTR) has been described as a common condition after isolated mitral valve (MV) surgery, affecting patients’ prognosis. Thus, in cases without significant tricuspid regurgitation (TR) but tricuspid annular (TA) dilatation, TV annuloplasty is currently recommended. Studies suggesting the currently used cut-off for definition of TA dilatation were based on 2D echocardiography (2DE) and included patients treated with MV surgery with heterogeneous MV disease, degree of cardiac remodeling and heart rhythm. As the management of severe MR has moved towards an earlier surgical treatment, few data are available about the incidence of FTR in the population undergoing early isolated MV surgery without TR, but 2DE satisfying criteria for TA dilatation.   Aims. To test, in patients treated with early isolated MV surgery for MV prolapse (MVP), without TR and either normal or dilated TA (i) if the currently used 2D TA cut-off is predictive of FTR and cardiac events development (ii) how right chambers’ remodeling assessed by 3D echocardiography (3DE) affects TA dimension. Methods. We studied 159 patients (age 61 ± 11) treated with early isolated MV surgery between 2010 and 2017. Eligible patients were those with 3DE images; normal left and right ventricular (LV and RV) function; sinus rhythm; normal or elevated right ventricular systolic pulmonary artery pressure (sPAP); normal or dilated TA by 2DE; absent TR. The decision to not perform TV annuloplasty in patients with TA dilatation was based on the surgical inspection. All patients underwent a complete 2DE, 3DE analysis was performed using custom software, including LV, RV, left atrial (LA) and right atrial (RA) assessment. 3D TA dimension were obtained using MPR. Clinical and 2DE follow-up was performed at 36 ± 6 months after surgery, major adverse cardiac events (MACEs, including cardiac hospitalization, cardiac death, arrhythmias) and FTR were recorded. Results. Based on 2DE TA dimensions, patients were divided in group 1 (N = 68, 43%, TA≥21 mm/m²) and group 2 (N= 91, 57%, normal TA). Patients in group 1 showed larger RA volume, RV basal diameter and TA area (p &lt; 0.05) by 3DE compared to group 2 (Table). At the multivariate analysis, only the 3D RA volume, RV basal diameter and RV function were independently correlated to the TA area (p &lt; 0.05). At the follow-up, no differences were noted between groups in FTR development and MACEs at the Kaplan-Meier analysis (Fig.). At the COX analysis, 2DE TA dilatation failed to result a predictor of cardiovascular events (model’s X2, p &gt; 0.05). Conclusions. In patients undergoing early MV surgery, the currently defined TA dilatation by 2DE may not necessarily evolve in FTR, and a larger cut-off may be needed. In this population, the evaluation of right chambers’ dimension and function may better define the probability to develop FTR. Abstract Figure. Fig

scholarly journals Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery

2013 ◽  
Vol 146 (5) ◽  
pp. 1092-1097 ◽  
Author(s):  
Sun Kyun Ro ◽  
Joon Bum Kim ◽  
Sung Ho Jung ◽  
Suk Jung Choo ◽  
Cheol Hyun Chung ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Tricuspid Regurgitation ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Functional Tricuspid Regurgitation

Exclusion versus preservation of the left atrial appendage in rheumatic mitral valve surgery

Heart ◽  
2020 ◽  
Vol 106 (23) ◽  
pp. 1839-1846 ◽  
Author(s):  
Wan Kee Kim ◽  
Ho Jin Kim ◽  
Joon Bum Kim ◽  
Sung Ho Jung ◽  
Suk Jung Choo ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Mitral Valve Surgery ◽  
Atrial Appendage ◽  
Clinical Events ◽  
Propensity Matching ◽  
Mitral Surgery ◽  
The Impact

ObjectivesThis study aimed to evaluate the impact of left atrial appendage exclusion on clinical outcomes in patients with atrial fibrillation (AF) undergoing rheumatic mitral surgery.MethodsWe retrospectively reviewed 1226 consecutive patients with AF (54.5±11.6 years; 68.2% females) who underwent rheumatic mitral valve (MV) surgery from 1997 to 2016. The left atrial appendage was preserved in 836 (68.2%) and excluded in 390 (31.8%) patients. Surgical AF ablation was performed in 506 (60.5%) and 304 (77.9%) patients with preserved and excluded left atrial appendage, respectively. For baseline adjustment, propensity matching was used.ResultsDuring a median follow-up of 63.4 months (IQRs, 20–111 months), there were no significant intergroup differences in the risks of mortality (2.77% vs 3.03%/patient-years) and thromboembolic events (0.91% vs 1.02%/patient-years). In the 258 pairs of propensity-score matched patients, death (2.77% vs 3.03%/patient-years) and thromboembolism (1.36% vs 0.82%/patient-years) outcomes were comparable for both groups. In a subgroup undergoing ablation (n=810), there were no significant differences in the adjusted risks of death (HR, 0.67; 95% CI, 0.34 to 1.32) and thromboembolism (HR, 0.47; 95% CI, 0.18 to 1.26). In a subgroup not undergoing ablation (n=416), however, left atrial appendage preservation tended to have higher adjusted risks for death (HR, 2.24; 95% CI, 0.98 to 5.13) and thromboembolism (HR, 4.41; 95% CI, 0.97 to 20.1).ConclusionsLeft atrial appendage preservation did not seem to have greater risks of adverse clinical events in patients with AF undergoing rheumatic MV surgery particularly when ablation procedure is combined.

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