Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery

Ro, Sun Kyun; Kim, Joon Bum; Jung, Sung Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

doi:10.1016/j.jtcvs.2012.07.100

Cited by 52 publications

(35 citation statements)

References 15 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…TR is also associated with increased late postoperative morbidity and mortality. [2][3][4][5][6][7] The timing of tricuspid valve surgery is important because patients with TR have anemia, organ dysfunction, and right ventricular (RV) dilatation, which also are associated with poor surgical outcomes. 8 Structural heart changes in severe TR are well described and include tricuspid annular dilation and RV and right atrial (RA) enlargement.…”

mentioning

confidence: 99%

Pathogenic structural heart changes in early tricuspid regurgitation

Nemoto

Lesser

Pedersen

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 99%

Pathogenic structural heart changes in early tricuspid regurgitation

Nemoto

Lesser

Pedersen

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…Nowadays, the increased need for TA is due to the aggressive approach chosen by the surgeons. According to the literature, 2,5,11,19 in most cases functional TR is not reduced after treatment of MV disease, but, after an early downgrading, it slowly increases again. Hence, surgery is indicated in patients with severe TR and should be considered in patients with mild or moderate TR with a tricuspid annulus ≥40 mm 3,4,19 .…”

Section: Discussionmentioning

confidence: 99%

“…Since Dreyfus et al 2 demonstrated that TR may further impair even after successful mitral valve (MV) surgery, most surgeons started to treat less than severe TR in the presence of a dilated annulus (>40 mm or >21 mm/m 2 ) 3,4 . However, the results of tricuspid annuloplasty (TA) still flawed, hence prophylactic TA remains underused, 5 performed only in 10% of patients with MV disease 6…”

Section: Introductionmentioning

confidence: 99%

Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

“…The observation that FTR could progress after successful MV replacement or repair was paramount to force surgeons to correct even less than severe FTR in the presence of a dilated annulus (>40 mm or >21 mm/m²). The results of surgical correction are, however, still flawed, and prophylactic tricuspid annuloplasty (TAP) remains controversial and underused, being performed only in 10% of patients with MV disease…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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 |

show abstract

Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery

Cited by 52 publications

References 15 publications

Pathogenic structural heart changes in early tricuspid regurgitation

Pathogenic structural heart changes in early tricuspid regurgitation

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

Contact Info

Product

Resources

About