Abstract

BackgroundIn patients with mild to moderate functional tricuspid regurgitation (TR) and absence of right ventricular dysfunction or tricuspid annulus (TA) dilatation, there is currently no indication for concomitant tricuspid valve (TV) repair during elective mitral valve (MV) surgery. However, long-term results are conflicting. Here, we sought to determine the clinical outcome of this cohort, the rate of TR progression after MV surgery and the role of MV aetiology.MethodsPatients for elective MV surgery without concomitant TV repair were retrospectively analysed with longitudinal echocardiographic and clinical follow-up, focusing on TR progression and MV aetiology. Linear regression analysis was performed for change in TR at follow-up, using pre-determined variables and confounders.ResultsIn total 204 patients without TV repair were analysed. Development of more than moderate TR after a median of 3.1 [1.6–4.6] years was rarely seen: only in 2 out of 161 patients (1.2%) with known TR grade at follow-up. Overall, median preoperative and late postoperative TR grade were equal (p = 0.116). Subanalysis showed no significant difference in MV aetiology subgroups. Preoperative TR grade and male gender were inversely correlated to change in TR. Mortality was not influenced by the 1‑year postoperative TR severity.ConclusionOur data showed that in a study population of patients with mild to moderate TR undergoing MV surgery without concomitant TV repair, significant late TR was rarely seen. Based on our study, it is safe to waive concomitant TV repair in this specific patient cohort.Electronic supplementary materialThe online version of this article (10.1007/s12471-018-1159-4) contains supplementary material, which is available to authorized users.

Highlights

  • In patients with mild to moderate functional tricuspid regurgitation (TR) and absence of right ventricular dysfunction or tricuspid annulus (TA) dilatation, there is currently no indication for concomitant tricuspid valve (TV) repair during elective mitral valve (MV) surgery

  • ● Our study showed that in patients with moderate TR or less, undergoing mitral valve (MV) surgery without concomitant TV repair, significant late functional TR was seldom seen, and change in TR severity was not influenced by the MV aetiology

  • NYHA class, EuroSCORE and rates of the comorbidities hypertension, chronic obstructive pulmonary disease, known coronary artery disease, diabetes, and renal failure were significantly higher in the functional aetiology subgroup, for ischaemic mitral regurgitation (MR)

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Summary

Objectives

The purpose of this study was to evaluate the echocardiographic and clinical results in patients with moderate TR or less, undergoing MV surgery without concomitant TV repair, in order to: (1) analyse postoperative TR progression and clinical outcome, and (2) evaluate the role of MV aetiology as potential risk factor for postoperative TR progression

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