Evolution of Tricuspid Regurgitation after Mitral Valve Surgery for Patients with Moderate-or-Less Functional Tricuspid Regurgitation
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.
Alexiou C, Doukas G, Oc M, et al. 2007. The effect of preoperative atrial fibrillation on survival following mitral valve repair for degenerative mitral regurgitation. Eur J Cardiothorac Surg 31:586-91.nCalafiore AM, Di Mauro M, Gallina S, et al. 2004. Mitral valve surgery for chronic ischemic mitral regurgitation. Ann Thorac Surg 77:1989-97.nCalafiore AM, Gallina S, Iacò AL, et al. 2009. Mitral valve surgery for functional mitral regurgitation: should moderate-or-more tricuspid regurgitation be treated? A propensity score analysis. Ann Thorac Surg 87:698-703.nColombo T, Russo C, Ciliberto GR, et al. 2001. Tricuspid regurgitation secondary to mitral valve disease: tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg 9:369-77.nde Bonis M, Lapenna E, Sorrentino F, et al. 2008. Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy. Eur J Cardiothorac Surg 33:600-6.nDi Mauro M, Bivona A, Iacò AL, et al. 2009. Mitral valve surgery for functional mitral regurgitation: prognostic role of tricuspid regurgitation. Eur J Cardiothorac Surg 35:635-9.nDreyfus GD, Corbi PJ, Chan KM, Bahrami T. 2005. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg 79:127-32.nFukuda S, Saracino G, Matsumura Y, et al. 2006. Three-dimensional geometry of the tricuspid annulus in healthy subjects and in patients with functional tricuspid regurgitation: a real-time, 3-dimensional echocardiographic study. Circulation 114: I492-8.nGhanta RK, Chen R, Narayanasamy N, et al. 2007. Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation: midterm results of 237 consecutive patients. J Thorac Cardiovasc Surg 133:117-26.nGuenther T, Noebauer C, Mazzitelli D, Busch R, Tassani-Prell P, Lange R. 2008. Tricuspid valve surgery: a thirty-year assessment of early and late outcome. Eur J Cardiothorac Surg 34:402-9.nKim HK, Kim YJ, Kim KI, et al. 2005. Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time. Circulation 112:I14-9.nKim HK, Kim YJ, Park JS, et al. 2006. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol 98:236-42.nKoelling TM, Aaronson KD, Cody RJ, Bach DS, Armstrong WF. 2002. Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction. Am Heart J 144:524-9.nLouagie Y, Buche M, Eucher P, et al. 2009. Improved patient survival with concomitant Cox maze III procedure compared with heart surgery alone. Ann Thorac Surg 87:440-6.nMatsunaga A, Duran CM. 2005. Progression of tricuspid regurgitation after repaired functional ischemic mitral regurgitation. Circulation 112:I453-7.nMatsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T. 2003. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg 75:1826-8.nMcCarthy PM, Bhudia SK, Rajeswaran J, et al. 2004. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg 127:674-85.nNath J, Foster E, Heidenreich PA. 2004. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 43:405-9.nNgaage DL, Schaff HV, Mullany CJ, et al. 2007. Influence of preoperative atrial fibrillation on late results of mitral repair: is concomitant ablation justified? Ann Thorac Surg 84:434-42.nShiran A, Sagie A. 2009. Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol 53:401-8.nTang GH, David TE, Singh SK, Maganti MD, Armstrong S, Borger MA. 2006. Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes. Circulation 114:I577-81.nTon-Nu TT, Levine RA, Handschumacher MD, et al. 2006. Geometric determinants of functional tricuspid regurgitation: insights from 3-dimensional echocardiography. Circulation 114:143-9.nVaturi M, Sagie A, Shapira Y, et al. 2001. Impact of atrial fibrillation on clinical status, atrial size and hemodynamics in patients after mitral valve replacement. J Heart Valve Dis 10:763-6.nWang G, Sun Z, Xia J, et al. 2008. Predictors of secondary tricuspid regurgitation after left-sided valve replacement. Surg Today 38:778-83.nZoghbi WA, Enriquez-Sarano M, Foster E, et al. 2003. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777-802.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).