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The online version of this article (https://doi.org/10.1007/s12471-018-1159-4) contains supplementary material, which is available to authorized users.
The Authors R. Jansen and B.R. van Klarenbosch contributed equally to the manuscript.
In patients with mild to moderate functional tricuspid regurgitation (TR) and absence of right ventricular dysfunction or tricuspid annulus (TA) dilatation, there is currently no indication for concomitant tricuspid valve (TV) repair during elective mitral valve (MV) surgery. However, long-term results are conflicting. Here, we sought to determine the clinical outcome of this cohort, the rate of TR progression after MV surgery and the role of MV aetiology.
Patients for elective MV surgery without concomitant TV repair were retrospectively analysed with longitudinal echocardiographic and clinical follow-up, focusing on TR progression and MV aetiology. Linear regression analysis was performed for change in TR at follow-up, using pre-determined variables and confounders.
In total 204 patients without TV repair were analysed. Development of more than moderate TR after a median of 3.1 [1.6–4.6] years was rarely seen: only in 2 out of 161 patients (1.2%) with known TR grade at follow-up. Overall, median preoperative and late postoperative TR grade were equal (p = 0.116). Subanalysis showed no significant difference in MV aetiology subgroups. Preoperative TR grade and male gender were inversely correlated to change in TR. Mortality was not influenced by the 1‑year postoperative TR severity.
Our data showed that in a study population of patients with mild to moderate TR undergoing MV surgery without concomitant TV repair, significant late TR was rarely seen. Based on our study, it is safe to waive concomitant TV repair in this specific patient cohort.
Online Resource 1: Subcategories for the types of mitral valve etiology (figure). Online Resource 2 reflects the univariable and multivariable analysis in change in tricuspid regurgitation grade (n = 161) between baseline and most recent echocardiographic follow-up, and pre-determined variables of interest at baseline (table)12471_2018_1159_MOESM1_ESM.docx
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368:1005–11. CrossRef
Cohen SR, Sell JE, McIntosh CL, Clark RE. Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation. I. Prevalence, diagnosis, and comparison of preoperative clinical and hemodynamic features in patients with and without tricuspid regurgitation. J Thorac Cardiovasc Surg. 1987;94:481–7. PubMed
Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004;43:405–9. CrossRef
Braunwald NS, Ross J Jr., Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation. 1967;35:I63–I9. CrossRef
Ariyoshi T, Hashizume K, Taniguchi S, et al. Which type of secondary tricuspid regurgitation accompanying mitral valve disease should be surgically treated? Ann Thorac Cardiovasc Surg. 2013;19:428–34. CrossRef
De Bonis M, Lapenna E, Pozzoli A, et al. Mitral valve repair without repair of moderate tricuspid regurgitation. Ann Thorac Surg. 2015;100:2206–12. CrossRef
Kwak JJ, Kim YJ, Kim MK, et al. Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations. Am Heart J. 2008;155:732–7. CrossRef
Goldstone AB, Howard JL, Cohen JE, et al. Natural history of coexistent tricuspid regurgitation in patients with degenerative mitral valve disease: implications for future guidelines. J Thorac Cardiovasc Surg. 2014;148:2802–9. CrossRef
Xiao XJ, Huang HL, Zhang JF, et al. Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement. Heart Lung Circ. 2004;13:65–9. CrossRef
Baumgartner H, Falk V, Bax JJ, et al. ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91. CrossRef
Nishimura RA, Otto CM, Bonow RO, et al. AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148:e1–e132. CrossRef
Desai RR, Vargas Abello LM, Klein AL, et al. Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. J Thorac Cardiovasc Surg. 2013;146:1126–32. CrossRef
Dreyfus J, Durand-Viel G, Raffoul R, et al. Comparison of 2‑dimensional, 3‑dimensional, and surgical measurements of the tricuspid annulus size: clinical implications. Circ Cardiovasc Imaging. 2015;8:e3241. CrossRef
Dreyfus GD, Corbi PJ, Chan KM, Bahrami T. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg. 2005;79:127–32. CrossRef
van de Veire NR, Braun J, Delgado V, et al. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg. 2011;141:1431–9. CrossRef
Lee H, Sung K, Kim WS, et al. Clinical and hemodynamic influences of prophylactic tricuspid annuloplasty in mechanical mitral valve replacement. J Thorac Cardiovasc Surg. 2016;151:788–95. CrossRef
Badhwar V, Rankin JS, He M, et al. Performing concomitant tricuspid valve repair at the time of mitral valve operations is not associated with increased operative mortality. Ann Thorac Surg. 2017;103:587–93. CrossRef
Navia JL, Brozzi NA, Klein AL, et al. Moderate tricuspid regurgitation with left-sided degenerative heart valve disease: to repair or not to repair? Ann Thorac Surg. 2012;93:59–67. CrossRef
Calafiore AM, Iaco AL, Romeo A, et al. Echocardiographic-based treatment of functional tricuspid regurgitation. J Thorac Cardiovasc Surg. 2011;142:308–13. CrossRef
Kim JB, Yoo DG, Kim GS, et al. Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes. Heart. 2012;98:24–30. CrossRef
Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013;14:611–44. CrossRef
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–70. CrossRef
Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol. 2009;53:401–8. CrossRef
Song H, Kim MJ, Chung CH, et al. Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery. Heart. 2009;95:931–6. CrossRef
Kitai T, Furukawa Y, Murotani K, et al. Therapeutic strategy for functional tricuspid regurgitation in patients undergoing mitral valve repair for severe mitral regurgitation. Int J Cardiol. 2017;227:803–7. CrossRef
Chikwe J, Itagaki S, Anyanwu A, Adams DH. Impact of concomitant tricuspid annuloplasty on tricuspid regurgitation, right ventricular function, and pulmonary artery hypertension after repair of mitral valve prolapse. J Am Coll Cardiol. 2015;65:1931–8. CrossRef
Matsunaga A, Duran CM. Progression of tricuspid regurgitation after repaired functional ischemic mitral regurgitation. Circulation. 2005;112:I453–I7. CrossRef
Di Mauro M, Bivona A, Iaco AL, et al. Mitral valve surgery for functional mitral regurgitation: prognostic role of tricuspid regurgitation. Eur J Cardiothorac Surg. 2009;35:635–9. CrossRef
Yilmaz O, Suri RM, Dearani JA, et al. Functional tricuspid regurgitation at the time of mitral valve repair for degenerative leaflet prolapse: the case for a selective approach. J Thorac Cardiovasc Surg. 2011;142:608–13. CrossRef
Fukuda S, Gillinov AM, Song JM, et al. Echocardiographic insights into atrial and ventricular mechanisms of functional tricuspid regurgitation. Am Heart J. 2006;152:1208–14. CrossRef
Calafiore AM, Gallina S, Iaco AL, et al. Mitral valve surgery for functional mitral regurgitation: should moderate-or-more tricuspid regurgitation be treated?A propensity score analysis. Ann Thorac Surg. 2009;87:698–703. CrossRef
- Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair
B. R. van Klarenbosch
M. J. Cramer
R. C. A. Meijer
P. H. M. Westendorp
H. W. J. Meijburg
J. J. J. Bucx
S. A. J. Chamuleau
- Bohn Stafleu van Loghum