Severe tricuspid regurgitation after mitral valve surgery: the risk factors and results of the aggressive application of prophylactic tricuspid valve repair

Hiroshi Takano,Mitsunori Kaneko,Keiwa Kin,Mitsuru Uenoyama,Hirota Kida,Yukitoshi Shirakawa,Takashi Daimon,Kei Horiguchi,Takashi Yamauchi,Miyoko Hiramatsu

doi:10.1007/s00595-016-1395-4

Abstract

PurposeThis study aimed to examine the risk factors for severe postoperative tricuspid regurgitation (TR) in patients undergoing mitral valve surgery. We also studied the effects of prophylactic tricuspid valve repair (TVR) on severe postoperative TR.MethodsWe retrospectively studied 125 patients without severe TR who underwent mitral valve surgery from 1987 to 2006. Patients did not undergo TVR before 1998 (the early period, n = 54). In 1998 (the late period, n = 71), patients with a preoperative tricuspid annular diameter of ≥35 mm underwent TVR using an annuloplasty ring (n = 52).ResultsIn the analysis of the early period, the rates of freedom from severe TR at 10 and 20 years after surgery were 76 and 59 %, respectively. A multivariate analysis identified moderate preoperative TR as a significant risk factor for severe TR. In the late period, none of the 52 patients who underwent TVR developed severe TR. However, 4/19 patients who did not undergo TVR developed severe TR, and all of these four patients had a preoperative tricuspid annular diameter of ≤35 mm.ConclusionsModerate preoperative TR is a significant risk factor for severe postoperative TR in patients undergoing mitral valve surgery. The aggressive application of TVR can prevent severe postoperative TR; however, tricuspid annular dilatation might not be a good indicator for TVR.

Highlights

Severe tricuspid regurgitation (TR) is associated with a reduction in exercise capacity and a poor functional outcome [1, 2]
The aggressive application of tricuspid valve repair (TVR) can prevent severe postoperative TR; tricuspid annular dilatation might not be a good indicator for TVR
We excluded cases involving severe preoperative TR (n = 81), patients in whom the tricuspid annular diameter (TAD) was not measured (n = 9), patients who died within 1 year after surgery (n = 9), patients with the postoperative recurrence of significant mitral valve disease or periprosthetic valvular leakage (n = 7), patients who were lost to follow-up within 1 year (n = 4), and patients with organic tricuspid valve disease (n = 2)

Summary

Introduction

Severe tricuspid regurgitation (TR) is associated with a reduction in exercise capacity and a poor functional outcome [1, 2]. Patients with severe TR who undergo mitral valve surgery should undergo concomitant tricuspid valve repair (TVR) because TR does not usually resolve if only the mitral valve is repaired. It remains unclear whether patients with moderate or mild TR should undergo TVR at the time of mitral valve surgery. Some patients with moderate or mild preoperative TR develop severe late postoperative TR [3,4,5,6,7,8,9]. The recent guidelines for the management of valvular heart disease from the European Society of Cardiology/European Association for Cardio-thoracic Surgery [11] and the American College of Cardiology/American Heart Association [12] recommend that concomitant TVR should be considered in patients with tricuspid annular dilatation, prior evidence of right heart failure, or pulmonary hypertension (recommendation class IIa or IIb)

Objectives

Methods

Results

Discussion

Conclusion