Additive and independent prognostic role of abnormal right ventricle and pulmonary hypertension in mitral-tricuspid surgery

Mauro, Michele Di; Foschi, Massimiliano; Tancredi, Fabrizio; Guarracini, Stefano; Marco, Massimo Di; Habib, Aly Makram; Kheirallah, Hatim; Alsaied, Mojtaba; Alfonso, Juan J.; Gallina, Sabina; Calafiore, Antonio M.

doi:10.1016/j.ijcard.2017.11.031

Cited by 23 publications

(30 citation statements)

References 26 publications

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“…TV apparatus remodeling was defined according to at least one of the following cutoff: CD ≥ 6.5 mm, tenting area ≥0.85 cm 2 , tricuspid annulus ≥35 mm. RV dilation was defined as a basal end‐diastolic diameter >42 mm and/or mid‐level diameter >35 mm 4,8,9 . RV dysfunction was defined as tricuspid annular plane systolic excursion <16 mm and/or tissue Doppler S′ velocity <10 cm/s 8 .…”

Section: Methodsmentioning

confidence: 99%

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Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty

et al. 2020

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Background The aim of the present retrospective study was to evaluate the influence of preoperative right ventricular (RV) and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and right ventricle. Methods From May 2009 to December 2015, 423 patients who had undergone TA for functional tricuspid regurgitation (TR) were included in the study. Residual and recurrent TR were defined as moderate or more TR at discharge and follow‐up, respectively. RV remodeling was defined as RV dysfunction and/or dilation. Results Residual TR after TA was recorded in 54 patients (13%). Five‐year freedom from TR recurrence was 81% ± 3% in patients without residual TR and 41 ± 8 in patients with residual TR (P < .001). In patients without residual TR, the following risk factors for recurrent TR and late RV remodeling were identified: preoperative systolic pulmonary artery pressure, preoperative RV remodeling, severe preoperative TR or less than severe TR but with TV apparatus remodeling, and etiology of mitral regurgitation. Cox analysis with time‐dependent variables confirmed TR recurrence (hazard ratio [HR]: 3.1) and late RV remodeling (HR: 6.5) as risk factors for lower survival. No protective effect of either flexible band or rigid ring TA compared with DeVega procedure was found. Similarly, preoperative atrial fibrillation and pacemaker dependency, late failure of mitral valve surgery did not affect the fate of TR. Conclusions Prophylactic TA should be encouraged among surgeons. TA at the time of left‐sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.

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Section: Methodsmentioning

confidence: 99%

“…RV remodeling was defined as either RV dilation or dysfunction. Systolic pulmonary artery pressure (sPAP) >55 mm Hg was considered as severe pulmonary hypertension 8‐10 . Failure of MV surgery at follow‐up was defined as either a MV area ≤1.5 cm 2 or recurrent MR.…”

Section: Methodsmentioning

confidence: 99%

Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty

et al. 2020

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“…The RV dimensions were measured at the basal level at end‐diastole. RV dilatation was defined as a basal end‐diastolic diameter >42 mm and/or mid‐level diameter >35 mm . Tricuspid annular plane systolic excursion (TAPSE) and/or tissue Doppler peak systolic tricuspid annular velocity (TDI S') were assessed to evaluate RV function.…”

Section: Methodsmentioning

confidence: 99%

Early failure of tricuspid annuloplasty. Should we repair the tricuspid valve at an earlier stage? The role of right ventricle and tricuspid apparatus

et al. 2019

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Background: We sought to identify subgroups of patients at a higher probability of tricuspid annuloplasty (TAP) failure early after surgery.Methods: From May 2009 to December 2015, 688 patients undergoing TAP for functional tricuspid regurgitation (FTR) at a single institution were included in the study. In all patients, a complete transthoracic echocardiographic evaluation of right ventricle (RV) and tricuspid valve (TV) apparatus was collected.Results: Twenty-six patients (3.8%) died within the first 30 days of surgery. Residual TR after TAP was recorded in 85 (12.4%), moderate in 80 (11.7%) and severe in 5 (0.7%). Preoperative TV apparatus remodeling was associated with residual TR; in particular, the following cutoffs were identified: TV coaptation depth ≥6.5 mm, tenting area ≥0.85 cm 2 , and tricuspid annulus ≥35 mm. The entire cohort was stratified in three subsets: patients having preoperative mild/moderate TR without preoperative TV apparatus and/or RV remodeling (n = 178); patients having mild/ moderate TR with TV apparatus and/or RV remodeling (n = 317); patients with severe TR regardless of TV apparatus and/or RV remodeling (n = 193). Residual TR was 2.8%, 10.4%, and 24.3%, respectively (P < 0.001). At multivariable analysis, patients showing preoperative mild/moderate TR with TV apparatus and/or RV remodeling as well as patients with severe TR were at significantly higher risk for early failure. No difference was found regarding the type of TV repair performed.Conclusions: Prophylactic TAP should be encouraged among surgeons even earlier than guidelines recommend, and decision-making for the treatment of low-grade FTR at the time of left-sided valve surgery should take into consideration not only annular size but also tethering severity and RV dilatation. K E Y W O R D S right ventricular remodeling, tricuspid annuloplasty, tricuspid regurgitation J Card Surg. 2019;34:404-411. wileyonlinelibrary.com/journal/jocs 404 |

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“…]35 mm) 5 .RV dilatation was defined as a basal end-diastolic diameter >42 mm and/or mid-level diameter >35 mm 7,8 . RV dysfunction was defined as TAPSE <16 mm and/or TDI-S' velocity <10 cm/sec 7,8 . Right ventricular remodeling was defined as RV dilatation and/or dysfunction.…”

Section: Echocardiographic Evaluationmentioning

confidence: 99%

“…Right ventricular remodeling was defined as RV dilatation and/or dysfunction. A systolic pulmonary pressure (sPAP)>55mmHg was considered as severe pulmonary hypertension 7,8 . Failure of MV surgery at follow-up was defined MV area [?…”

Section: Echocardiographic Evaluationmentioning

confidence: 99%

Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty.

Calafiore¹,

Lorusso

Kheirallah³

et al.

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Background. We sought to determine the relationship between tricuspid right ventricular (RV) and tricuspid valve (TV) remodeling and late failure of tricuspid annuloplasty. Methods. From May 2009 to December 2015, 423 patients undergoing tricuspid annuloplasty (TA) for functional TR at a single were analyzed. Residual TR was defined TR moderate-or-more at discharge. Recurrent TR was defined TR-moderate-or-more at follow up. RV remodeling was defined RV dysfunction and/or dilatation. Results. Residual TR after TA was recorded in 54. Five-year freedom from TR recurrence was 86.3±2.3% for patients without residual TR vs 57.6±7.6% for patients with residual TR, p<0.001. Evaluating late results of 369 patients without residual TR, following risk factors were identified: preoperative pulmonary pressure, pre RV remodeling, pre TR and TV remodeling, functional mitral regurgitation. Conclusions. Prophylactic tricuspid annuloplasty should be encouraged among surgeons. TA at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.

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Additive and independent prognostic role of abnormal right ventricle and pulmonary hypertension in mitral-tricuspid surgery

Cited by 23 publications

References 26 publications

Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty

Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty

Early failure of tricuspid annuloplasty. Should we repair the tricuspid valve at an earlier stage? The role of right ventricle and tricuspid apparatus

Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty.

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