Original article
Cardiovascular
Secondary Tricuspid Regurgitation or Dilatation: Which Should Be the Criteria for Surgical Repair?

https://doi.org/10.1016/j.athoracsur.2004.06.057Get rights and content

Background

Secondary tricuspid dilatation may or not be accompanied by tricuspid regurgitation (TR). Tricuspid dilatation can be objectively measured whereas TR can vary according to the preload, afterload, and right ventricular function. The purpose of this prospective study was to determine whether surgical repair of the tricuspid valve based on tricuspid dilatation rather than TR could lead to potential benefits.

Methods

Between 1989 and 2001, 311 patients underwent mitral valve repair (MVR). The tricuspid valve was examined in each patient. Tricuspid annuloplasty was performed only if the tricuspid annular diameter was greater than twice the normal size (≥ 70 mm) regardless of the grade of regurgitation. Patients in group 1 (163 patients; 52.4%) received MVR alone. Patients in group 2 (148 patients; 47.6%) received MVR plus tricuspid annuloplasty.

Results

Although not significant there was a difference with regard to hospital mortality (group 1 = 1.8%, group 2 = 0.7%) and actuarial survival rate (Kaplan–Meier: group 1 = 97.3%, 96.2%, and 85.5%; group 2 = 98.5%, 98.5%, and 90.3% at 3, 5, and 10 years, respectively). The New York Heart Association (NYHA) functional class was significantly improved in group 2 (group 1 = 1.59 ± 0.84; group 2 = 1.11 ± 0.31; p1). TR increased by more than two grades in 48% of the patients in group 1 and in only 2% of the patients in group 2 (p < 0.001).

Conclusions

Remodeling annuloplasty of the tricuspid valve based on tricuspid dilation improves functional status irrespective of the grade of regurgitation. Considerable tricuspid dilatation can be present even in the absence of substantial TR. Tricuspid dilatation is an ongoing disease process that will, with time, lead to severe TR.

Section snippets

Material and Methods

Three-hundred eleven patients with chronic severe mitral regurgitation (MR) received mitral valve repairs (MVR) between April 1989 and February 2001. After approval by the local ethics committee, all patients were operated on by one surgeon in the same institution. Concomitant TVR was performed in 148 patients. All patients were operated through median sternotomy under cardiopulmonary bypass at normothermia. Double venous cannulation was used. Myocardial protection consisted of antegrade cold

Results

The preoperative patient demographics are listed in Table 1. There was no statistical evidence of a difference between the two groups with regard to age, sex, incidence of atrial fibrillation, ejection fraction, and NYHA functional class. The etiology of MR was similar in both groups with the predominant etiology being degenerative (Table 2).

Preoperative TR grading was performed using transthoracic echocardiography. The results are given in Table 3. The mean TR grade was 0.7 ± 0.5 in group 1

Comment

The presence of secondary tricuspid pathology is often not appreciated especially if severe TR is not present. Although there is no question that considerable tricuspid pathology is present when there is severe TR, considerable tricuspid pathology may also be present when the severity of TR is only mild or moderate [8]. This is because the assessment of the tricuspid valve at a given time by echocardiography is dependent upon the preload and afterload conditions of the patient and these

Cited by (0)

View full text
Copyright © 2005 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.