Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure.

Desai, Ravi R

Vargas Abello, Lina Maria

Klein, Allan L

Marwick, Thomas H

Krasuski, Richard A

Ye, Ying

Nowicki, Edward R

Rajeswaran, Jeevanantham

Blackstone, Eugene H

Pettersson, Gösta B

United States

2015-12-03T17:05:28Z

2013-11

OBJECTIVES: To study the effect of mitral valve repair with or without concomitant tricuspid valve repair on functional tricuspid regurgitation and right ventricular function. METHODS: From 2001 to 2007, 1833 patients with degenerative mitral valve disease, a structurally normal tricuspid valve, and no coronary artery disease underwent mitral valve repair, and 67 underwent concomitant tricuspid valve repair. Right ventricular function (myocardial performance index and tricuspid annular plane systolic excursion) was measured before and after surgery using transthoracic echocardiography for randomly selected patients with tricuspid regurgitation grade 0, 1+, and 2+ (100 patients for each grade) and 93 with grade 3+/4+, 393 patients in total. RESULTS: In patients with mild (<3+) preoperative tricuspid regurgitation, mitral valve repair alone was associated with reduced tricuspid regurgitation and mild worsening of right ventricular function. Tricuspid regurgitation of 2+ or greater developed in fewer than 20%, and right ventricular function had improved, but not to preoperative levels, at 3 years. In patients with severe (3+/4+) preoperative tricuspid regurgitation, mitral valve repair alone reduced tricuspid regurgitation and improved right ventricular function; however, tricuspid regurgitation of 2+ or greater returned and right ventricular function worsened toward preoperative levels within 3 years. Concomitant tricuspid valve repair effectively eliminated severe tricuspid regurgitation and improved right ventricular function. Also, over time, tricuspid regurgitation did not return and right ventricular function continued to improve to levels comparable to that of patients with lower grades of preoperative tricuspid regurgitation. CONCLUSIONS: In patients with mitral valve disease and severe tricuspid regurgitation, mitral valve repair alone was associated with improved tricuspid regurgitation and right ventricular function. However, the improvements were incomplete and temporary. In contrast, concomitant tricuspid valve repair effectively and durably eliminated severe tricuspid regurgitation and improved right ventricular function toward normal, supporting an aggressive approach to important functional tricuspid regurgitation.

http://www.ncbi.nlm.nih.gov/pubmed/23010580

S0022-5223(12)01076-8

1097-685X

https://hdl.handle.net/10161/10991

eng

Elsevier BV

J Thorac Cardiovasc Surg

10.1016/j.jtcvs.2012.08.061

35

MPI

MR

MVR

RV

TAPSE

TR

TTE

TV

TVR

mitral regurgitation

mitral valve repair

myocardial performance index

right ventricular

transthoracic echocardiogram

tricuspid annular plane systolic excursion

tricuspid regurgitation

tricuspid valve

tricuspid valve repair

Cardiac Surgical Procedures

Chi-Square Distribution

Female

Humans

Linear Models

Logistic Models

Male

Markov Chains

Mitral Valve Insufficiency

Monte Carlo Method

Multivariate Analysis

Recovery of Function

Severity of Illness Index

Time Factors

Treatment Outcome

Tricuspid Valve Insufficiency

Ventricular Dysfunction, Right

Ventricular Function, Right

Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure.

Journal article

Krasuski, Richard A|0000-0003-3150-5215

http://www.ncbi.nlm.nih.gov/pubmed/23010580

1126

1132.e10

5

Clinical Science Departments

Duke

Faculty

Medicine

Medicine, Cardiology

School of Medicine

Published

146