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Impact of the Maze operation on the progression of mild functional tricuspid regurgitation.
MedLine Citation:
PMID:  19026801     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: In patients having mitral valve surgery, concomitant surgery for mild functional tricuspid regurgitation remains the subject of debate. This study examined the effect of Maze operation and tricuspid valve repair on postoperative functional tricuspid regurgitation progression. METHODS: The study retrospectively analyzed 250 patients (86 men, 164 women) with mild functional tricuspid regurgitation (grade 2) who had mitral valve surgery between January 1994 and July 2006. Based on follow-up data, patients were defined as either stable (n = 209, 83.6%) or aggravated (n = 41, 16.4%). Predictors for significant tricuspid regurgitation development were identified using Cox regression analysis. RESULTS: The mean follow-up time was 62.6 +/- 39.8 months after surgery. Although most mitral valve procedures were successful, there was an increase in the incidence of significant functional tricuspid regurgitation overall from immediately postoperative to final assessment (5.2% to 16.4%, P < 0.01). Univariate analysis showed that old age, shorter aortic crossclamping time, and omission of Maze operation were associated with functional tricuspid regurgitation progression. Multivariate analysis showed that older age (adjusted hazard ratio, 1.05; 95% confidence interval, 1.02 to 1.08), a rheumatic etiology of the mitral valve disease (adjusted hazard ratio, 2.31; 95% confidence interval, 1.21 to 4.42), and no Maze operation (adjusted hazard ratio, 7.90; 95% confidence interval, 1.90 to 32.86) were independent predictors of mild functional tricuspid regurgitation progression. For the 168 patients with preoperative atrial fibrillation, Maze operation improved the tricuspid regurgitation-free survival significantly (P < .01) but tricuspid valve repair showed no significant difference. CONCLUSIONS: Mild functional tricuspid regurgitation can progress postoperatively despite successful mitral valve surgery. Although tricuspid valve repairs alleviate progression of functional tricuspid regurgitation, concomitant Maze operation is a more powerful protective factor against mild functional tricuspid regurgitation progression.
Authors:
Hyung Gon Je; Hyun Song; Sung Ho Jung; Suk Jung Choo; Jong Min Song; Duk Hyun Kang; Sung Cheol Yun; Cheol Hyun Chung; Jae Kawn Song; Jae Won Lee
Publication Detail:
Type:  Journal Article     Date:  2008-09-23
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  136     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-25     Completed Date:  2008-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1187-92     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Cardiac Surgical Procedures / methods*
Disease Progression
Disease-Free Survival
Echocardiography
Female
Follow-Up Studies
Humans
Male
Middle Aged
Mitral Valve / surgery*
Proportional Hazards Models
Reoperation
Retrospective Studies
Tricuspid Valve Insufficiency / mortality,  physiopathology*,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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