Fate of Functional Tricuspid Regurgitation After Mitral Valve Repair for Degenerative Mitral Regurgitation

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp plasty ring over suture annuloplasty. 4, 9 We have consistently performed TAP using a flexible ring or band for >10 years.This study assessed late survival and freedom from recurrent or progressive FTR following TAP for FTR. Additionally, the effect of residual TR on late outcome was investigated. MethodsThis retrospective study was approved by the institutional review board. We retrospectively reviewed the medical records of 220 patients (mean age, 65.4±11.4 years; range, 16-83 years) who underwent TAP for FTR in the setting of mitral valve surgery at Kobe City Medical Center General Hospital between January 2000 and December 2010. Of 220 patients, 160 (72.7%) underwent mitral valve repair (MVP), and 60 (27.3%) underwent mitral valve replacement (MVR). Patient preoperative characteristics are listed in Table 1. With regard to mitral etiology, degenerative entities comprised 94% in patients who had MVP, and rheumatic disease accounted for 87% in those unctional tricuspid regurgitation (FTR) mainly occurs because of tricuspid annular dilation and right ventricular enlargement and/or right ventricular dysfunction in mitral valve diseases. 1,2 FTR causes further right ventricular dilatation, dysfunction, or more annular dilatation, subsequently worsening FTR. 1 Increasing severity of FTR is associated with poor survival in healthy men irrespective of left ventricular function or pulmonary hypertension. 3 Despite improved understanding of FTR and its surgical management, reports of late survival associated with FTR are limited. Guenther et al showed that 10-year survival after tricuspid annuloplasty (TAP) was 46%, 4 and Pfannmuller et al showed that 5-year survival was approximately 60%. 5 Persistent FTR after mitral prosthetic replacement is reported to be a risk factor for postoperative congestive heart failure and late mortality. 6 In redo series of mitral valve surgery, persistent FTR had a negative effect on late survival. 7 FTR after TAP in redo valvular surgery also affected late outcome. 8 Evidence supports the superiority of TAP with an annulo- We assessed late outcome after tricuspid annuloplasty (TAP) using a flexible band or ring for functional tricuspid regurgitation (FTR).

Section: Figure 2 Freedom From Recurrent Tricuspid Regurgitation (Trmentioning

confidence: 99%

Late Outcome of Tricuspid Annuloplasty Using a Flexible Band/Ring for Functional Tricuspid Regurgitation

Fukunaga

Okada

Konishi

et al. 2015

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“…7 In accordance with current trends, we are alternatively using a prosthetic ring for TR as an initial surgery as described previously. 8 It has also been used in redo valve surgery at Kobe City Medical Center General Hospital.…”

Section: Discussionmentioning

confidence: 99%

Persistent Tricuspid Regurgitation After Tricuspid Annuloplasty During Redo Valve Surgery Affects Late Survival and Valve-Related Events

Fukunaga

Okada

Konishi

et al. 2014

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2696FUKUNAGA N et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp positive or negative data concerning TR in that setting. Also, redo surgery for late TR is associated with a high hospital mortality rate and poor survival, which may lead to avoidance of surgery to treat TR. 4 We reviewed our 20-year surgical experience with TAP performed to alleviate TR during redo surgery. We focused on the long-term survival and incidence of recurrent or progression of late TR in patients who had undergone TAP. MethodsThis study was approved by the institutional review board at Kobe City Medical Center General Hospital. We retrospectively analyzed 125 patients who underwent TAP using suture (n=54; group S) or ring (n=71; group R) implantation techniques during redo valve surgery over a 20-year period (January 1990-December 2010. During the same period, tricuspid valve replacement (TVR) was performed in 13 cases. The indications ome reports have described the late results and durability of tricuspid valve annuloplasty (TAP) for tricuspid regurgitation (TR) in the setting of an initial surgery. McCarthy et al reported a 5-year survival rate of 65% and a 97% rate of freedom from reoperation at 8 years. 1 Guenther et al found that the 10-year survival and freedom from reoperation after TAP with a prosthetic ring were 46% and 98%, respectively. 2 Given that the number of mitral valve operations is increasing, careful attention has been paid to functional TR. The number of TAP is also increasing because it has become common during initial mitral valve surgery.In the setting of redo valve surgery, however, TAP for TR has not been universal. Severe isolated TR was recognized in only 6.2% of the patients who underwent left-sided heart valve surgery. 3 Few publications have described results of late TR during redo surgery. TR tended to be ignored during redo surgery compared to the initial surgery because of a shortage of Background: Long-term survival and incidence of late tricuspid regurgitation (TR) were studied in patients who underwent tricuspid annuloplasty (TAP) during redo valve surgery.

“…To be included in the present study, the following 3 preoperative echocardiographic criteria for severe TR were required: (1) TR jet >30% of the right atrial (RA) area; (2) inadequate cusp coaptation; and (3) systolic flow reversal in the hepatic vein. 7, 8 Inadequate coaptation of the tricuspid valve was determined to be present when the gap between the septal and anterior leaflets of the tricuspid valve that was measured using zoomed images of the modified apical 4-chamber view was visually identified and estimated to be ≥5 mm. Inadequate coaptation was linked to tricuspid annular dilation and apical tethering of the leaflets in all patients.…”

Section: Study Patientsmentioning

confidence: 99%

“…1, 2 In addition, TR development, long after left-sided valve surgery, is closely linked to exercise intolerance and presages a poor outcome, 3-5 even in the absence of left ventricular (LV) dysfunction or pulmonary hypertension. [6][7][8] In this respect, corrective surgery for TR is considered a reliable therapeutic option if it is performed in a timely manner. 3,9- 12 In addition to improvements in symptoms and survival, timely performed corrective TR surgery can cause right ventricular (RV) reverse remodeling.…”

mentioning

confidence: 99%

Right Ventricular Reverse Remodeling, but not Subjective Clinical Amelioration, Predicts Long-Term Outcome After Surgery for Isolated Severe Tricuspid Regurgitation

Kim

Lee

et al. 2014

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp lthough tricuspid regurgitation (TR) has long been neglected based on the false belief that it is extremely rare and not clinically significant, recent studies have shown that it is not a rare disease, and that its prevalence is progressively growing, especially long after left-sided valve surgery. 1,2 In addition, TR development, long after left-sided valve surgery, is closely linked to exercise intolerance and presages a poor outcome, 3-5 even in the absence of left ventricular (LV) dysfunction or pulmonary hypertension. 6-8 In this respect, corrective surgery for TR is considered a reliable therapeutic option if it is performed in a timely manner. 3,9-12 In addition to improvements in symptoms and survival, timely performed corrective TR surgery can cause right ventricular (RV) reverse remodeling. 3,9-11 However, the response to corrective TR surgery varies significantly among patients; some patients experience a significant improvement in subjective symptoms such as exertional dyspnea along with RV reverse remodeling, whereas other patients show no improvement or deterioration of subjective symptoms, but with evident echocardiographic RV reverse remodeling, or vice versa. Thus, we do not know which factor (subjective symptoms or objective RV reverse remodeling) is more trustworthy for predicting the long-term outcome after corrective TR surgery.Hence, the aim of this prospective study was 2-fold: (1) to evaluate the degree of (dis)agreement between subjectively symptomatic amelioration and echocardiographic improvement at 6 months after corrective TR surgery; and (2) to investigate which of the 2 factors is more predictive of a better long-term Background: Subjective clinical improvement does not always go hand-in-hand with right ventricular (RV) reverse remodeling after surgery for isolated severe tricuspid regurgitation (TR). This study aimed to evaluate the level of agreement between clinical improvement and echocardiographic RV reverse remodeling, and determine the relative prognostic powers of these 2 factors in terms of long-term prognosis for patients with isolated TR surgery.