Definitive Determinant of Late Significant Tricuspid Regurgitation After Aortic Valve Replacement

Yajima, Satoshi; Yoshioka, Daisuke; Toda, Köichi; Fukushima, Satsuki; Miyagawa, Shigeru; Yoshikawa, Yasushi; Saito, Shunsuke; Domae, Keitaro; Ueno, Takayoshi; Kuratani, Toru; Sawa, Yoshiki

doi:10.1253/circj.cj-17-0996

Cited by 12 publications

(8 citation statements)

References 23 publications

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“…Accurate preoperative risk evaluation is essential to identify patients at high risk and improve clinical outcome. Previous studies have demonstrated that TR can cause liver8, 9 and renal dysfunction10; nonetheless their prognostic value in patients with TA is largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Chen

Liu

Seto

et al. 2018

JAHA

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BackgroundThe Model for End‐stage Liver Disease excluding international normalized ratio (MELD‐XI) score and the modified MELD score with albumin replacing international normalized ratio (MELD‐Albumin) score, which reflect both liver and renal function, have been reported as predictors of adverse events in liver and heart disease. Nonetheless, their prognostic value in patients undergoing tricuspid annuloplasty has not been addressed.Methods and ResultsA total of 394 patients who underwent tricuspid annuloplasty were evaluated. Baseline clinical, laboratory, and echocardiographic parameters were recorded. Adverse outcome was defined as the occurrence of heart failure requiring admission or all‐cause mortality. Patients who underwent tricuspid annuloplasty had a high prevalence of preoperative hepatorenal dysfunction that was more common in patients with severe tricuspid regurgitation than those with mild to moderate tricuspid regurgitation. The MELD‐XI and MELD‐Albumin scores were excellent predictors of 1‐year adverse outcome (area under the curve: 0.69 and 0.75, respectively). Kaplan–Meier survival curve demonstrated that a high score on MELD‐XI (≥12.0) and MELD‐Albumin (≥10.7) was associated with an increased risk of adverse events. During a median follow‐up of 40 months, both MELD‐XI and MELD‐Albumin scores were significantly associated with adverse outcome, even after adjusting for potential confounding factors. Significant improvement of hepatorenal function at 1 year postoperation was noted only in patients who had no adverse events, not in those who experienced an adverse outcome.ConclusionsBoth MELD‐XI score and MELD‐Albumin score can provide useful information to predict adverse outcome in patients undergoing tricuspid annuloplasty. The present study supports monitoring of modified MELD score to improve preoperative risk stratification of these patients.

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Section: Introductionmentioning

confidence: 99%

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Chen

Liu

Seto

et al. 2018

JAHA

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“…That study design was not similar to ours, as they followed up patients with preserved left ventricular functions and atrial fibrillation; but the result was statistically very significant as increased left atrial diameter caused progression in TI and increased primary endpoints. In patients undergoing aortic valve replacement, left atrial diameter was also reported to be a prognostic factor for progression of functional TI [Yajima 2018]. Conversely, in a study aimed to document a tricuspid annular circumference index, there was no correlation between patients with a left atrial diameter <60 mm and >60 mm.…”

Section: Discussionmentioning

confidence: 94%

Predictors for Progression of Tricuspid Insufficiency Following Left-Sided Valvular Surgery: A Retrospective Cohort Study

Aydın

Demircin

Doğan

et al. 2019

HSF

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Background: The operative indications for severe tricuspid insufficiency in patients undergoing left-sided valvular surgery are well defined; however, for mild and moderate insufficiency, the findings are still controversial. In this study, we aimed to document the prognostic parameters for progression of tricuspid insufficiency in patients undergoing left-sided valvular surgery. Methods: 135 patients undergoing mitral valve ± coronary bypass surgery were retrospectively examined. Patients with simultaneous tricuspid valve surgery were excluded. Demographic, clinical, and laboratory findings were recorded and the relationship with progression of tricuspid insufficiency was studied. Results: Valvular pathology was rheumatic in origin in 72.6% of patients. Tricuspid insufficiency was progressed in 69 (51.1%) of patients, while it did not change in 66 (48.9%) patients. Echocardiographic parameters recorded during follow-up revealed that left ventricular end-diastolic diameter decreased, while there was no significant change in right ventricular end-diastolic diameter. Tricuspid insufficiency was directly related with right ventricular end-diastolic diameter (P < .05), while no relationship was documented with left ventricular end-diastolic diameter. There was a statistically significant correlation between postoperative progression of tricuspid insufficiency and left atrial diameter; however, no relationship was documented with age, sex, valvular disease etiology, comorbidities, or preoperative atrial fibrillation. Risk factor analysis revealed that left atrial diameter was the only prognostic factor. Conclusion: The indications for mild and moderate tricuspid insufficiency are still not clear for patients undergoing left-sided valvular surgery. In this study, we documented that left atrial dilatation was a prognostic factor for progression of postoperative tricuspid insufficiency. In this group of patients, presence of left atrial dilatation may be an indication for tricuspid valve intervention.

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“…Taramasso et al investigated 61 patients with severe AS associated with mild or moderate TR to evaluate the prognostic impact and late changes in the preoperative TR after SAVR, and found that preoperative untreated TR improved or remained stable in the majority of patients [40]. Yajima et al examined changes in untreated mild or moderate TR after SAVR and its long-term impact on outcome, and found that preoperative TR was aggravated after isolated SAVR, resulting in a high incidence of renal dysfunction and right heart failure, and that tricuspid annulus diameter index (≧ 21 mm/M 2 ) was a predictor of late significant TR [41].…”

Section: Savr and Concomitant Tap For Severe As Patients With Functiomentioning

confidence: 99%

Surgical Therapy for Patients with Severe Aortic Stenosis in the Era of Transcatheter Aortic Valve Replacement

Nishimura

Yasutsune

Ikushima

et al. 2019

J UOEH

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Aortic stenosis (AS) is the most common valvular heart disease and is most frequently recognized among elderly people. Surgical aortic valve replacement (SAVR) is the most effective therapy, but its indication is sometimes difficult, and is impossible for high operative risk patients. Transcatheter aortic valve replacement (TAVR) was recently approved in Japan for high risk and inoperable patients with severe AS. TAVR is a less invasive method because it does not require a cardiopulmonary bypass and is associated with excellent surgical outcomes. In Western countries, the indication of TAVR has already been extended to moderate operative risk patients with severe AS, and is going to be further extended to low risk patients. The number of patients undergoing TAVR is increasing progressively, and there are effective alternative therapies for patients with severe AS. Selection of these surgical methods will be important in the near future. In regard to low operative risk patients especially, not only operative mortality, but also long-tern mortality and morbidity and quality of life should be taken into consideration. It is considered that some comorbidities in AS patients will be revealed to have an impact on surgical outcomes at the time when these surgical methods are selected. In this review, we examine end-stage renal disease on hemodialysis, functional tricuspid regurgitation, and sigmoid septum, and give an outline of what influence SAVR and TAVR have on the surgical outcomes of severe AS patients.

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Definitive Determinant of Late Significant Tricuspid Regurgitation After Aortic Valve Replacement

Cited by 12 publications

References 23 publications

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Predictors for Progression of Tricuspid Insufficiency Following Left-Sided Valvular Surgery: A Retrospective Cohort Study

Surgical Therapy for Patients with Severe Aortic Stenosis in the Era of Transcatheter Aortic Valve Replacement

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