Abstract

ObjectiveWe investigated the effect of morphological diversity of the tricuspid valve with multiple posterior leaflets on the technical outcomes of tricuspid valve repair.MethodsFrom April 2016 to November 2020, 141 patients were diagnosed with secondary tricuspid regurgitation associated with left heart disease and underwent tricuspid valve repair. We retrospectively analyzed the clinical and echocardiographic data of patients who underwent both preoperative and postoperative transthoracic echocardiography. We divided the patients into two groups according to the surgical technique used to treat tricuspid regurgitation: ring annuloplasty alone (Group 1, n = 109) or additional approximation of leaflet edges (edge-to-edge repair) with ring annuloplasty (Group 2, n = 32). We measured the morphological diversity of the tricuspid valve during the operation in all patients.ResultsThe preoperative tricuspid regurgitation score was higher in Group 2 than in Group 1 (2.1 ± 0.78 vs. 1.6 ± 0.7, respectively; p = 0.0046), and Group 2 contained more patients with two posterior leaflets than Group 1 [20 (63%) vs. 36 (33%), respectively; p = 0.003]. The univariate and multivariate logistic regression analyses showed that the presence of two posterior leaflets was an independent risk factor for additional procedures during tricuspid valve repair (odds ratio, 2.6; 95% confidence interval, 1.1–6.1; p = 0.033).ConclusionsAdditional procedures to reduce tricuspid regurgitation were required more frequently in patients with two posterior leaflets of the tricuspid valve. The morphological diversity of two posterior leaflets is a potential risk factor for a more complicated tricuspid repair.

Highlights

  • Several studies have focused on the anatomy and pathophysiology of secondary tricuspid regurgitation (TR) associated with left heart disease or atrial fibrillation [1, 2]

  • Sakon et al [10] recently demonstrated that the number of posterior leaflets was two or more in a half of the Kawase et al Journal of Cardiothoracic Surgery (2022) 17:18 patients analyzed in their study

  • Patient’s profiles (Table 1) A total of 32 (23%) patients needed an additional procedure with ring annuloplasty to reduce TR

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Summary

Introduction

Several studies have focused on the anatomy and pathophysiology of secondary tricuspid regurgitation (TR) associated with left heart disease or atrial fibrillation [1, 2]. Patients with significant TR, especially that in the severe range, have a poor prognosis [3, 4]. Sakon et al [10] recently demonstrated that the number of posterior leaflets was two or more in a half of the Kawase et al Journal of Cardiothoracic Surgery (2022) 17:18 patients analyzed in their study. No studies have shown that morphological diversity of the TV affects the outcomes and surgical techniques of TV repair. The present study was performed to investigate the effect of morphological diversity of the TV on the difficulty of controlling TR during TV repair

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