Abstract
BackgroundStudies on the management of functional tricuspid regurgitation (TR) during mitral valve operations have drawn inconsistent conclusions. This study was designed to compare the treatment strategy of concomitant tricuspid annuloplasty (TAP) against isolated mitral valve replacement (MVR) in rheumatic mitral valve disease patients, and to assess the effect of concomitant TAP on postoperative right ventricular (RV) remodeling and function.MethodsOne hundred-seventy patients with rheumatic mitral valve disease receiving MVR were categorized into TAP group (n = 124) and non-TAP group (n = 46). Clinical and echocardiographic data were collected preoperatively and at 1-year follow-up. Three-dimensional echocardiographic indices of RV geometry and function were analyzed.ResultsAt baseline, concomitant TAP group had larger RV end-diastolic volume, more decreased RV ejection fraction and RV longitudinal strain than non-TAP group (all P < 0.001). At 1-year follow-up, TAP group had improved RV geometry and function. While adverse changes were observed in non-TAP group. In analysis of variance, the above indices demonstrated significant interaction with different treatment group (all P < 0.001). In multivariate regression analysis, independent of age and Maze procedure, concomitant TAP was associated with postoperative RV volume reduction (P < 0.001), improvement of RV ejection fraction (P < 0.001), and relieved postoperative functional TR severity (P = 0.025).ConclusionsOur results suggest that concomitant TAP could improve RV remodeling and function for rheumatic mitral valve disease patients, while those with mild preoperative functional TR who had isolated MVR might experience RV dilation and deterioration of RV function at follow-up. Concomitant surgery for functional TR could be considered for patients undergoing MVR with rheumatic mitral valve disease.
Highlights
Concomitant tricuspid annuloplasty (TAP) at the time of mitral surgery has gained growing acceptance recently
Data regarding the effect of TAP is inconclusive in patients with rheumatic mitral valve disease
Baseline characteristics and the effect of TAP at follow-up Among the 176 patients enrolled in this study, 6 patients were deceased within 6 months after the surgery, with 5 patients in the TAP group (3 patients deceased before discharge due to postoperative complication, 1 died of heart failure 1 month after the operation, 1 had sudden death 4 months after the operation, the cumulative survival rate was 96.1%), and 1 patient in the non-TAP group
Summary
Concomitant tricuspid annuloplasty (TAP) at the time of mitral surgery has gained growing acceptance recently. Despite surgical repair for severe tricuspid regurgitation (TR) at the time of left-sided valve surgery is a Class I recommendation under the current guidelines, the optimal management for moderate and mild functional TR depends more on whether the patient had dilated tricuspid annulus and/or right heart failure [1, 2]. Previous studies mostly focused on degenerative and functional mitral valve disease, which have shown that for moderate and severe preoperative TR, concomitant TAP could improve postoperative right ventricular (RV) function, leading to favorable RV remodeling [4, 5]. This study was designed to compare the treatment strategy of concomitant tricuspid annuloplasty (TAP) against isolated mitral valve replacement (MVR) in rheumatic mitral valve disease patients, and to assess the effect of concomitant TAP on postoperative right ventricular (RV) remodeling and function
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