Clinical Outcomes After Tricuspid Valve Annuloplasty in Addition to Mitral Valve Surgery

Abstract

©2012 Wiley Periodicals, inc. Current guidelines recommend tricuspid valve annuloplasty (TVP) together with mitral valve surgery in cases of tricuspid annulus dilation (≥40 mm) or functional tricuspid valve regurgitation >2/4. Baseline clinical and echocardiographic data of patients undergoing mitral valve surgery in a single tertiary care hospital between 2007 and 2010 were analyzed. Mortality and heart failure hospitalization data were collected and groups with or without TVP were compared. Patients with TVP (n=89) had similar baseline characteristics compared with patients without (n=86), except for lower right ventricular fractional area change and more concomitant aortic valve surgery. Mortality was higher in the TVP group at 30 days (14% vs 5%; P=.04), but the difference was no longer significant at the end of follow‐up. More patients were hospitalized for heart failure in the TVP group (31% vs 17%; hazard ratio, 2.1; 95% confidence interval, 1.1–4.0; P=.05). Right ventricular sphericity index was the only preoperative parameter predicting death or heart failure hospitalizations. In conclusion, patients undergoing TVP in addition to mitral valve surgery are at high risk for early death or subsequent heart failure hospitalizations, which might be partly explained by more complex heart disease. The extent of preoperative right ventricular remodeling may be predictive of adverse outcomes.

Additional tricuspid annuloplasty in mitral valve surgery results in better clinical outcome

“…These data were adjusted for LV parameters, as possible confounders of outcome. Opposed to this, several studies failed to show that TA is beneficial in patients with other causes of MR 16 17. Especially in degenerative mitral valve disease, the value of TA is controversial.…”

“…Comparison of the outcome in patients undergoing MVS with or without TA is notoriously difficult because the former often present in a worse clinical state with more severe TR, higher New York Heart Association (NYHA) functional class and decreased RV function 3. Cross-sectional studies therefore failed to show improved outcome for patients undergoing simultaneous TA and MVS in the past 16 17…”

Predictive value of acute kidney injury for major adverse cardiovascular events following tricuspid annuloplasty: A comparison of three consensus criteria

“…As well as mortality, a prior study [33] and our recent data [34] demonstrated that the risk of heart failure that requires admission following TA is as high as 40%. The present result that includes a large cohort of patients who underwent TA, confirms that heart failure is common and constitutes the majority of MACE (67%).…”

The best approach for functional tricuspid regurgitation: A network meta‐analysis

“…After exclusion of duplicate or irrelevant references, 114 potentially relevant articles were retrieved. After application of the inclusion and exclusion criteria, 31 relevant articles were included in the study 5,12,21‐49 : randomized trials ( n = 3), 24,42,45 propensity score‐adjusted ( n = 4), 12,26,31,46 and observational non‐adjusted ( n = 24) 5,20‐22,24,26‐29,31‐43,45‐48 …”

“…After application of the inclusion and exclusion criteria, 31 relevant articles were included in the study 5,12, : randomized trials (n = 3), 24,42,45 propensity score-adjusted (n = 4), 12,26,31,46 and observational non-adjusted (n = 24). 5,[20][21][22]24,[26][27][28][29][31][32][33][34][35][36][37][38][39][40][41][42][43][45][46][47][48] A total of 9663 patients were included for analysis. Among them, the funnel plots did not show significant asymmetry to suggest publication bias with outcomes selected (Figure S2).…”