Determinants of recurrent tricuspid regurgitation following tricuspid valve annuloplasty during mitral valve surgery

Ito, Hisato; Mizumoto, Toru; Sawada, Yasuhiro; Fujinaga, Kazuya; Tempaku, Hironori; Shimpo, Hideto

doi:10.1111/jocs.13117

Cited by 13 publications

(18 citation statements)

References 23 publications

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“…Looking at the survival rates in terms of procedural groups, there was no significant difference among the groups. A durable mitral valve repair and preservation of sinus rhythm are the keys to preventing late TR progression (27). The present study, the only parameter of preoperative AF was significantly lower in no-TAP group.…”

Section: Discussionsupporting

confidence: 41%

The Factors Affecting Long Term Tricuspid Regurgitation After Double Valve Replacement

Aksoy

Çevirme

et al. 2020

Preprint

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Background: This study aims to determine the hemodynamic performance of double valve prostheses and its effects on long term outcomes of tricuspid regurgitation(TR) following double valve replacement (DVR). Methods: Between January 2014-September 2017, all patients undergoing concomitant aortic and mitral valve replacement with or without concomitant tricuspid valve repair at the same center were reviewed. All patients were divided into three groups according to interventions tricuspid valve(TVI), that is no-tricuspid annuloplasty(TAP), tricuspid ring annuloplasty and tricuspid de-vega annuloplasty (TDVA).Results: The study included 179 patients, of whom 52% were women(with mean age 51.7±13.7 years). Of 179 patients, 100 were in the no-TAP group, 39 were in the ring annuloplasty group and 40 were in the TDVA group. There was no statically significant difference among the groups with regard to potential complications, in-hospital mortality and the survival rates. The degree of TR decreased with TVI. The rates of moderate and severe TR were significantly lower in in the ring annuloplasty group (P = 0.04 and 0.004). Female gender (OR = 4.0, 95%CI: 1.0-15.5, p = 0.05) and preoperative TR degree(OR = 2.9, 95%CI: 1.1-7.3, p = 0.01) were an independent predictors for the development of postoperative severe TR. Conclusion: Although the degree of postoperative TR varies according to whether to perform a TVI, DVR can be safe due to low operative mortality independently from TVI. The rates of moderate and severe TR were significantly lower in the ring annuloplasty group and female gender was an independent risk factor of TR progression.

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Section: Discussionsupporting

confidence: 41%

The Factors Affecting Long Term Tricuspid Regurgitation After Double Valve Replacement

Aksoy

Çevirme

et al. 2020

Preprint

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“…Whether the surgical technique could influence TR recurrence remains debated 30‐33 . In our experience, no difference was observed according to the surgical strategy.…”

Section: Discussionmentioning

confidence: 57%

Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty

et al. 2020

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Background The aim of the present retrospective study was to evaluate the influence of preoperative right ventricular (RV) and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and right ventricle. Methods From May 2009 to December 2015, 423 patients who had undergone TA for functional tricuspid regurgitation (TR) were included in the study. Residual and recurrent TR were defined as moderate or more TR at discharge and follow‐up, respectively. RV remodeling was defined as RV dysfunction and/or dilation. Results Residual TR after TA was recorded in 54 patients (13%). Five‐year freedom from TR recurrence was 81% ± 3% in patients without residual TR and 41 ± 8 in patients with residual TR (P < .001). In patients without residual TR, the following risk factors for recurrent TR and late RV remodeling were identified: preoperative systolic pulmonary artery pressure, preoperative RV remodeling, severe preoperative TR or less than severe TR but with TV apparatus remodeling, and etiology of mitral regurgitation. Cox analysis with time‐dependent variables confirmed TR recurrence (hazard ratio [HR]: 3.1) and late RV remodeling (HR: 6.5) as risk factors for lower survival. No protective effect of either flexible band or rigid ring TA compared with DeVega procedure was found. Similarly, preoperative atrial fibrillation and pacemaker dependency, late failure of mitral valve surgery did not affect the fate of TR. Conclusions Prophylactic TA should be encouraged among surgeons. TA at the time of left‐sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.

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“…Whether the surgical technique used for TAP could affect surgical results remains a matter of debate . Many studies support the use of rigid, or flexible devices, or report similar results with suture annuloplasty vs flexible or rigid devices, or with flexible vs rigid devices .…”

Section: Discussionmentioning

confidence: 99%

Early failure of tricuspid annuloplasty. Should we repair the tricuspid valve at an earlier stage? The role of right ventricle and tricuspid apparatus

et al. 2019

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Background: We sought to identify subgroups of patients at a higher probability of tricuspid annuloplasty (TAP) failure early after surgery.Methods: From May 2009 to December 2015, 688 patients undergoing TAP for functional tricuspid regurgitation (FTR) at a single institution were included in the study. In all patients, a complete transthoracic echocardiographic evaluation of right ventricle (RV) and tricuspid valve (TV) apparatus was collected.Results: Twenty-six patients (3.8%) died within the first 30 days of surgery. Residual TR after TAP was recorded in 85 (12.4%), moderate in 80 (11.7%) and severe in 5 (0.7%). Preoperative TV apparatus remodeling was associated with residual TR; in particular, the following cutoffs were identified: TV coaptation depth ≥6.5 mm, tenting area ≥0.85 cm 2 , and tricuspid annulus ≥35 mm. The entire cohort was stratified in three subsets: patients having preoperative mild/moderate TR without preoperative TV apparatus and/or RV remodeling (n = 178); patients having mild/ moderate TR with TV apparatus and/or RV remodeling (n = 317); patients with severe TR regardless of TV apparatus and/or RV remodeling (n = 193). Residual TR was 2.8%, 10.4%, and 24.3%, respectively (P < 0.001). At multivariable analysis, patients showing preoperative mild/moderate TR with TV apparatus and/or RV remodeling as well as patients with severe TR were at significantly higher risk for early failure. No difference was found regarding the type of TV repair performed.Conclusions: Prophylactic TAP should be encouraged among surgeons even earlier than guidelines recommend, and decision-making for the treatment of low-grade FTR at the time of left-sided valve surgery should take into consideration not only annular size but also tethering severity and RV dilatation. K E Y W O R D S right ventricular remodeling, tricuspid annuloplasty, tricuspid regurgitation J Card Surg. 2019;34:404-411. wileyonlinelibrary.com/journal/jocs 404 |

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Determinants of recurrent tricuspid regurgitation following tricuspid valve annuloplasty during mitral valve surgery

Abstract: A durable mitral valve repair and preservation of sinus rhythm are the keys to preventing late TR progression.

Cited by 13 publications

References 23 publications

The Factors Affecting Long Term Tricuspid Regurgitation After Double Valve Replacement

The Factors Affecting Long Term Tricuspid Regurgitation After Double Valve Replacement

Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty

Early failure of tricuspid annuloplasty. Should we repair the tricuspid valve at an earlier stage? The role of right ventricle and tricuspid apparatus

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