Abstract
In patients with primary mitral regurgitation (MR), concomitant tricuspid valve (TV) annuloplasty at the time of left-sided valve surgery is indicated in case of a dilated TV annulus ≥40mm independent of the presence or severity of tricuspid regurgitation (TR). However, the long-term impact on right ventricular (RV) adverse remodeling is less well established and the benefit of preventive TV annuloplasty remains controversial. The aim of the study was to assess differences in long-term RV adverse remodeling and the development of significant TR in those patients. In total, 98 patients (mean age 65 ± 11years, 85% men) with significant primary MR and TV annulus dilatation ≥40mm without significant TR who underwent mitral valve (MV) repair with or without concomitant TV annuloplasty were included. Of the 98 patients, 28 patients underwent isolated MV repair without TV annuloplasty and 70 patients received concomitant TV annuloplasty at the time of MV surgery. The RV basal diameter (p=0.03), RV long-axis diameter (p=0.04), RV end-diastolic area (p <0.01), and RV end-systolic area (p=0.03) showed less adverse remodeling at follow-up in patients with concomitant TV annuloplasty compared with patients without TV annuloplasty. Additionally, 4 patients (14%) in the subgroup without TV annuloplasty developed significant TR during follow-up in contrast to zero patients in the subgroup with TV annuloplasty (p=0.001). In conclusion, concomitant preventive TV annuloplasty during MV surgery in patients with primary MR, no significant TR and a tricuspid annulus (≥40mm) prevented RV adverse remodeling and the development of significant TR at long-term follow-up.
Highlights
right ventricular (RV) basal diameter was dilated (50 § 5 mm) compared with the normal range (25 to 41 mm),[11] whereas RV midventricular diameter (32 § 6 mm) and longitudinal diameter (78 § 10 mm) were within the normal range (19 to 35 mm and 59 to 83 mm, respectively).[11]. Both subgroups with and without preventive tricuspid valve (TV) annuloplasty were comparable at baseline in terms of echocardiographic characteristics, preoperative RV function was more preserved in patients without TV annuloplasty
The main finding of the present study was that in patients with significant primary mitral regurgitation (MR) and a dilated tricuspid annulus (≥40 mm) without significant tricuspid regurgitation (TR) (
Previous studies have demonstrated that patients with RV dilatation who underwent TV annuloplasty during MV surgery were protected from development of significant TR and associated adverse RV remodeling in the first years after surgery.[7,15,16]
Summary
The aim of the study was to assess differences in long-term RV adverse remodeling and the development of significant TR in those patients. Various studies have confirmed reduction of TR after this procedure, the long-term impact on RV adverse remodeling and clinical outcomes is less well established and the benefit of preventive TV annuloplasty remains controversial.− the aim of the present study was to assess differences in long-term RV adverse remodeling and clinical outcomes in patients with significant primary mitral regurgitation (MR) and TV annulus dilatation ≥40 mm without significant TR who underwent MV surgery with versus without concomitant preventive TV annuloplasty
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