| Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement. | |
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MedLine Citation:
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PMID: 19766809 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The indications for tricuspid valve repair in the setting of mitral valve disease and concomitant tricuspid regurgitation (TR) remain unclear. We examined patients undergoing mitral valve replacement (MVR) to determine the effect of TR and tricuspid valve repair on survival, functional status, and postoperative TR. METHODS: Between 1990 and 2005, 624 patients underwent MVR. Data included detailed serial echocardiographic tricuspid valve measurements, functional status, and survival data. Preoperative TR exceeded 2+ in 231: 125 received tricuspid repair and MVR, whereas 106 received MVR alone. Clinical and echocardiographic follow-up were complete (average, 6.8 +/- 4.8 years). Parametric and semi-parametric tests were used to analyze outcomes. RESULTS: TR exceeding 2+ at operation was associated with a 53% increase in late death (p = 0.003). Tricuspid repair prevented echocardiographic progression of TR and improved congestive heart failure symptoms (both p < 0.01). Overall survival did not improve (p = 0.3). A trend to worsening TR in patients was noted with a larger tricuspid annulus diameter and without significant (<or= 1+) TR preoperatively (odds ratio, 1.4 per cm increase in annulus diameter; p = 0.5), but this was not associated with worse functional or vital outcomes. CONCLUSIONS: In patients undergoing MVR, tricuspid repair is indicated when TR exceeds 2+ to alleviate heart failure symptoms, but without significantly improving survival in this population. TR of 2+ or less may not require repair. Echocardiographic tricuspid annular dimensions alone, in the absence of significant (<or= 1+) TR preoperatively, should not dictate the performance of tricuspid repair. |
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Authors:
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Vincent Chan; Ian G Burwash; B-Khanh Lam; Titus Auyeung; Anthony Tran; Thierry G Mesana; Marc Ruel |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 88 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-09-21 Completed Date: 2009-10-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1209-15 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Echocardiography, Doppler / methods* Female Follow-Up Studies Heart Valve Prosthesis Implantation / methods* Humans Male Middle Aged Mitral Valve Insufficiency / complications, surgery*, ultrasonography Monitoring, Intraoperative Prognosis Retrospective Studies Severity of Illness Index Tricuspid Valve / physiopathology, ultrasonography* Tricuspid Valve Insufficiency / complications, physiopathology*, surgery |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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