TY - JOUR
T1 - Tricuspid regurgitation is uncommon after mitral valve repair for degenerative diseases
AU - David, Tirone E.
AU - David, Carolyn M.
AU - Fan, Chun Po S.
AU - Manlhiot, Cedric
N1 - Publisher Copyright:
© 2017 The American Association for Thoracic Surgery
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2017/7
Y1 - 2017/7
N2 - Objective To determine the incidence and effects of tricuspid regurgitation (TR) after surgery for mitral valve (MV) repair for mitral regurgitation (MR) due to degenerative disease. Patients and Methods We examined 1171 patients who had MV repair and were followed prospectively with periodical clinical and echocardiographic assessments during a mean of 9.1 ± 5.3 years. Patients' mean age was 58.2 ± 12.7 years, and 70.5% were men. Preoperatively, 44.6% were in functional classes III and IV, 20.1% had atrial fibrillation, and 34.2% had ejection fraction <60%. In addition to MV repair, 13.8% had coronary artery bypass, 11.4% had the maze procedure, and 4.7% had tricuspid annuloplasty. Results Moderate and severe TR was present in 138 patients before surgery and associated with older age, preoperative atrial fibrillation, preoperative congestive heart failure, congenital heart septal defects, lower preoperative left ventricular ejection fraction, and female sex by multivariable analysis. TR resolved postoperatively but recurrent or new isolated TR occurred in 45 patients postoperatively (13.6% at 15 years in all patients). Factors associated with isolated postoperative TR by multivariable analysis included older age at operation, unrepaired preoperative moderate/severe TR, and the development of postoperative MR. Patients with preoperative TR had reduced long-term survival and tricuspid annuloplasty did not restore lifespan. Conclusions Preoperative TR in patients with MR due to degenerative diseases was associated with longstanding MV disease and adversely affected long-term survival after MV repair. New postoperative TR was uncommon. The findings of this study are compelling reasons to repair the MV before the development of TR.
AB - Objective To determine the incidence and effects of tricuspid regurgitation (TR) after surgery for mitral valve (MV) repair for mitral regurgitation (MR) due to degenerative disease. Patients and Methods We examined 1171 patients who had MV repair and were followed prospectively with periodical clinical and echocardiographic assessments during a mean of 9.1 ± 5.3 years. Patients' mean age was 58.2 ± 12.7 years, and 70.5% were men. Preoperatively, 44.6% were in functional classes III and IV, 20.1% had atrial fibrillation, and 34.2% had ejection fraction <60%. In addition to MV repair, 13.8% had coronary artery bypass, 11.4% had the maze procedure, and 4.7% had tricuspid annuloplasty. Results Moderate and severe TR was present in 138 patients before surgery and associated with older age, preoperative atrial fibrillation, preoperative congestive heart failure, congenital heart septal defects, lower preoperative left ventricular ejection fraction, and female sex by multivariable analysis. TR resolved postoperatively but recurrent or new isolated TR occurred in 45 patients postoperatively (13.6% at 15 years in all patients). Factors associated with isolated postoperative TR by multivariable analysis included older age at operation, unrepaired preoperative moderate/severe TR, and the development of postoperative MR. Patients with preoperative TR had reduced long-term survival and tricuspid annuloplasty did not restore lifespan. Conclusions Preoperative TR in patients with MR due to degenerative diseases was associated with longstanding MV disease and adversely affected long-term survival after MV repair. New postoperative TR was uncommon. The findings of this study are compelling reasons to repair the MV before the development of TR.
KW - mitral insufficiency
KW - mitral valve repair
KW - tricuspid insufficiency
KW - tricuspid valve
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U2 - 10.1016/j.jtcvs.2016.12.046
DO - 10.1016/j.jtcvs.2016.12.046
M3 - Article
C2 - 28262288
AN - SCOPUS:85014068959
VL - 154
SP - 110-122.e1
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 1
ER -