A retrospective comparative analysis of trends of selected echocardiographic parameters in tricuspid valve repair with mitral valve replacement cases involving use of suture annuloplasty vs ring annuloplasty for tricuspid repair: A single-center study

Management of the bad atrioventricular valve in Fontan…time for a change

Historically, right-sided valvular disease has received less attention from clinicians and researchers than left-sided valve disease, in part because of a protracted latent asymptomatic period. Moreover, because tricuspid regurgitation (TR) is often due to left-sided valve disease and pulmonary regurgitation (PR) is often secondary to congenital cardiac disease, the underlying disorder rather than the valve lesion tends to dominate the clinical picture. It is increasingly recognized that right-sided valve disease is not benign and has a significant and independent impact on morbidity and mortality. Today, diagnostic techniques and appropriate management strategies for patients with right-sided valve disease are established and continually refined. In this era of increasing awareness and improved treatment options for patients with valve disease, it is important that clinicians consider the diagnosis of right-sided valve disease, understand its pathophysiology, choose appropriate confirmatory testing, and refer patients for timely intervention to prevent clinical deterioration with associated adverse consequences. This review examines the causes of right-sided valve disease and the latest diagnostic advances and treatment options for these often-neglected valve lesions. Patients with native right-sided valve disease are rarely affected by endocarditis, and indications for prophylaxis have recently changed.1 ### Tricuspid Regurgitation TR that is at least moderate in severity is most frequently “functional” in nature and by definition not related to primary tricuspid valve (TV) leaflet pathology but rather secondary to another disease process causing right ventricular (RV) dilatation, distortion of the subvalvular apparatus, tricuspid annular dilatation, or a combination of these. Furthermore, a moderate or greater degree of TR, regardless of primary origin, usually engenders additional TR as a result of the adverse hemodynamic consequence of RV volume overload. Causes of clinically significant TR are outlined in Table 1; 2 classic examples of primary tricuspid leaflet pathology are demonstrated in Figure 1. View this table: Table 1. Causes of TV …

Incidence and Risk Factors for Permanent Pacemaker Implantation After Tricuspid Valve Repair

Outcomes of ring versus suture annuloplasty for tricuspid valve repair in patients undergoing mitral valve surgery

Commentary: Mild tricuspid regurgitation in rheumatic mitral surgery: To do, or not do, that is the question

The Tricuspid Valve in Single-Ventricle Patients: Forgotten, Unforgivable, and Indispensable

Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of Fallot

Therapeutic strategy for functional tricuspid regurgitation in patients undergoing mitral valve repair for severe mitral regurgitation

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Which patient undergoing mitral valve surgery should also have the tricuspid repair?' Altogether 390 papers were found using the reported search, of which 17 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. While a general agreement exists for tricuspid valve (TV) repair in cases of severe regurgitation and concomitant multivalvular disease requiring surgical intervention, current guidelines provide more vague indications for patients with less severe tricuspid regurgitation (TR). Since this condition has a lower event-free survival rate and the prognosis after symptoms development is dismal, a lower threshold and a more aggressive strategy for intervention is needed. In rheumatic valve disease, mitral valve involvement and disease spreading to TV may be responsible for further regurgitation. Although patients with pulmonary hypertension (PH) may benefit from mitral valve replacement (MVR) or balloon valvotomy, many studies found that preoperative PH does not predict late TR. However, patients with high pulmonary pressure have a lower occurrence of late TR. Tricuspid annular dilation is probably the most important factor for late TR. Once established, it might be irreversible even after resolution of PH as well as absence of 'reverse remodelling'. It has been proposed to treat TR independently from the grade of regurgitation when the annular dimension is over 21 mm/m(2) or > or =3.5 cm at echo measurement or when the intra-operative tricuspid annulus (TA) diameter is >70 mm. TV repair should be accomplished in patients with preoperative atrial fibrillation (AF), since it may cause late significant TR development and affect the patient's long-term survival. The presence of a trans-tricuspid pacemaker lead is another known factor for late TR development secondary to adhesions and fibrous retraction. TV repair is probably better than replacement in non-severe organic TV disease. Annuloplasty ring repair has better outcome compared with non-ring based repair techniques; the beneficial effect is also independent of the type of mitral valve surgery performed.

This study aimed to compare long-term outcomes after tricuspid valve (TV) repair (TVr) with those after TV replacement (TVR) by adjusting the right ventricular (RV) volume and function. We enrolled 147 patients who underwent TVr (n = 78) and TVR (n = 69) for grade 3 or 4 tricuspid regurgitation and had preoperative cardiac magnetic resonance data. Long-term clinical outcomes were compared between the two groups using inverse probability treatment weighting (IPTW) to adjust for differences in preoperative characteristics between the two groups. Subgroup analyses were performed in patients with preserved and dysfunctional RV (ejection fraction < 50%). There were no significant differences in operative mortality or postoperative complications between the two groups before and after the IPTW adjustment. Five- and 10-year overall survival rates were 84.2 and 67.1%, respectively. Five- and 10-year cumulative incidences of TV-related events (TVREs) were 33.1 and 55.6%, respectively. There were no significant differences in overall survival and cumulative incidence of TVREs after IPTW adjustment (p = 0.236 and p = 0.989, respectively). The risk-adjusted overall survival was marginally higher in the TVr group of patients with preserved RV function (p = 0.054), while no such significant difference was found between the two groups of patients with dysfunctional RV (p = 0.513). Adjusted long-term clinical outcomes after TVr and TVR were comparable. TVr might be beneficial for patients with preserved RV function in terms of long-term survival; however, this benefit might disappear in patients with RV dysfunction.

Background: Secondary tricuspid regurgitation (TR) is a common finding in patients undergoing surgery for leftsided heart valve disease. The indications for concomitant tricuspid valve (TV) repair have been progressively expanded based on data suggesting adverse sequelae for patients in whom secondary TR is not treated. Method: This was a prospective observational study of patients undergoing left-sided valve surgery with at least mild TR. Eighty-three patients were enrolled between July 2019 - April 2021. Patients received either conservative management (no TV repair) or concomitant TV repair (TV repair) based upon a guidelinedirected, multidisciplinary team approach. Primary outcomes were freedom from recurrent TR, poor functional status, and mortality at 6 months. The secondary outcomes were to identify predictors of recurrent TR and compare no TV repair vs. TV repair outcomes in patients with moderate or severe pre-operative TR. Results: The mean age was 49 ± 15.5 years and 51.8% (43 of 83) were female. Thirty-seven (44.6%) had rheumatic heart disease. The most common procedures involved the mitral (50.6%) and aortic (28.9%) valves in isolation. Additional procedures were performed in 33 (39.8%) patients, including resection of the left atrial appendage in 21 (63.6%). Pre-operative moderate or severe TR was present in 34 (40.9%) patients, and TV repair was performed in 9 (10.8%) patients who all received rigid ring annuloplasty. At 6 months the 56 patients (67.5%) were free of significant TR, 14 (16.9%) were in a poor functional state and 72 (86.7%) were alive. Suggested predictors of recurrent TR at 6 months were female gender (OR 9.9, p=0.04), rheumatic leftsided valvopathy (OR 14.4, p=0.02), and elevated right ventricular systolic pressure (OR 1.1, p&lt;0.01). An exploratory sub-group analysis did not reveal any primary outcomes differences between no TV repair vs. TV repair at 6 months, despite the latter group demonstrating more high-risk features. Conclusion: Guideline-directed, multidisciplinary team approach for the management of secondary TR associated with left-sided valve disease produced good overall short-term outcomes that appeared similar whether or not the TV was repaired. Prospective studies with long-term outcomes are required to determine the optimal treatment strategy for secondary TR in patients undergoing left-sided valve surgery.

Moderate Tricuspid Regurgitation With Left-Sided Degenerative Heart Valve Disease: To Repair or Not to Repair?

Outcomes of Tricuspid Valve Repair and Replacement: A Propensity Analysis

Transatrial Antegrade Approach for Double Mitral and Tricuspid “Valve-in-Ring” Implantation

Tricuspid Valve Tethering Is Associated with Residual Regurgitation after Valve Repair in Hypoplastic Left Heart Syndrome: A Three-Dimensional Echocardiographic Study