Severe tricuspid regurgitation after mitral valve surgery: the risk factors and results of the aggressive application of prophylactic tricuspid valve repair

Abstract

PurposeThis study aimed to examine the risk factors for severe postoperative tricuspid regurgitation (TR) in patients undergoing mitral valve surgery. We also studied the effects of prophylactic tricuspid valve repair (TVR) on severe postoperative TR.MethodsWe retrospectively studied 125 patients without severe TR who underwent mitral valve surgery from 1987 to 2006. Patients did not undergo TVR before 1998 (the early period, n = 54). In 1998 (the late period, n = 71), patients with a preoperative tricuspid annular diameter of ≥35 mm underwent TVR using an annuloplasty ring (n = 52).ResultsIn the analysis of the early period, the rates of freedom from severe TR at 10 and 20 years after surgery were 76 and 59 %, respectively. A multivariate analysis identified moderate preoperative TR as a significant risk factor for severe TR. In the late period, none of the 52 patients who underwent TVR developed severe TR. However, 4/19 patients who did not undergo TVR developed severe TR, and all of these four patients had a preoperative tricuspid annular diameter of ≤35 mm.ConclusionsModerate preoperative TR is a significant risk factor for severe postoperative TR in patients undergoing mitral valve surgery. The aggressive application of TVR can prevent severe postoperative TR; however, tricuspid annular dilatation might not be a good indicator for TVR.

Effect of Concomitant Tricuspid Annuloplasty on Early Outcomes of Mitral Valve Replacement: A Study on Rheumatic Heart Disease Patients

“…This is, in part, due to the expectation that the improvement in mitral valve function may optimize hemodynamic parameters allowing for improved tricuspid function [ 4 ]. However, studies have shown that, in most cases, the correction of left-sided disease is insufficient to improve tricuspid dysfunction [ 13 - 14 ]. This is especially true for patients with moderate to severe tricuspid regurgitation.…”

Long-term outcomes of concomitant tricuspid valve repair in patients undergoing mitral valve surgery

“…One of the main rationales for performing concomitant TVR at the time of MVS is to prevent progression of TR and thus reduce the risk of a future need for reoperation to repair or replace the tricuspid valve [ 3 , 6 , 14 , 15 ]. Moderate preoperative TR is a risk factor for severe postoperative TR in patients who do not undergo a concomitant TVR at the time of MVS.…”

Early treatment of functional tricuspid regurgitation at the time of mitral valve surgery: an increased risk or an additional benefit?

“…They concluded that the De Vega annuloplasty is an acceptable strategy, improving both clinical and echocardiographic status of the patients during long-term follow-up, although the event-free survival appeared to be lower in comparison with that observed for the ring annuloplasty (74.5% vs. 78.8%, P = NS) [20] . Finally, Takano et al [21] in a smaller series of 71 patients undergoing mitral valve replacement and tricuspid valve repair, but with a follow-up period of 20 years, identified the preoperative moderate grade of FTR as a significant risk factor for the development of late severe tricuspid regurgitation. They claimed that an aggressive early treatment of FTR at the time of mitral valve surgery may prevent the late progression of the FTR.…”

“…[20] De Takano et al . [21] Ring implant 0 59% at 15 years 93% at 15 years Filsoufi et al . [25] Ring implant 5.3% 85% at 2 years 100% at 2 years Fukuda et al .…”