Prediction of Outcome in Patients Undergoing Surgery for Severe Tricuspid Regurgitation Following Mitral Valve Surgery and Role of Tricuspid Annular Systolic Velocity

Kwon, Dong A.; Park, Jin Shik; Chang, Hyuk Jae; Kim, Yong Jin; Sohn, Dae Won; Kim, Ki Bong; Ahn, Hyuk; Oh, Byung Hee; Park, Young Bae; Choi, Yun Shik

doi:10.1016/j.amjcard.2006.03.047

Cited by 108 publications

(63 citation statements)

References 14 publications

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“…As corrective surgery for late TR is associated with high operative mortality and morbidity, 8,9,19 its prevention has clinically important implications. Currently, tricuspid annuloplasty is widely performed as a safe and effective Comparison of event-free cumulative survival rates according to the presence or absence of late significant tricuspid regurgitation.…”

Section: Prevention Of Late Tr Developmentmentioning

confidence: 99%

Development of tricuspid regurgitation late after left-sided valve surgery: A single-center experience with long-term echocardiographic examinations

Kwak

Kim

et al. 2008

American Heart Journal

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171

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Objectives This study sought to investigate the incidence and identify the predictors of significant tricuspid regurgitation (TR) development long after left-sided valve surgery.Methods Of 615 patients who underwent surgery for left-sided valve disease between 1992 and 1995, 335 patients without significant TR who completed at least 5 years of clinical and echocardiographic follow-up were enrolled. Late significant TR development was assessed by echocardiography with a mean follow-up duration of 11.6 ± 2.1 years.Results Significant late TR was found in 90 patients (26.9%). Patients with late TR showed an advanced age (47.6 ± 13.4 vs 44.3 ± 13.2 years, P = .04), a higher prevalence of preoperative atrial fibrillation (83.3 vs 46.5%, P b .001), a greater left atrial dimension (56.9 ± 13.2 vs 52.4 ± 11.5mm, P = .006), and a higher prevalence of prior valve surgery (40.0 vs 25.3%, P = .01). In addition, late TR occurred more frequently in patients who had undergone mitral valve surgery than in those who did not (93.3 vs 72.2%, P b .001). However, multivariate analysis showed that the presence of preoperative atrial fibrillation (odds ratio 5.37; 95% CI 2.71-10.65; P b .001) was the only independent factor of late TR development. Patients who developed late TR had a lower event-free survival rate than those who did not (P = .03).Conclusions The development of significant TR long after left-sided valve surgery is not uncommon with an estimated incidence of 27% and is closely associated with a poor prognosis. The presence of preoperative atrial fibrillation was identified as the only independent predictor of the development of late TR. (Am Heart J 2008;155:732-7.) Tricuspid regurgitation (TR) is a common finding in patients undergoing mitral or combined mitral/aortic valve surgery. 1,2 Although TR may decrease gradually after left-sided valve surgery owing to reduced right ventricular pressure or volume overload, 3 TR does not always regress after adequate correction of the underlying lesions 4,5 and often progresses some time after surgery without leftsided valvular dysfunction, even after tricuspid annuloplasty. Furthermore, TR can appear de novo during postoperative follow-up. Because it is well known that TR progression badly affects long-term mortality and morbidity, and that surgical correction of TR after left-sided valve surgery is associated with disappointingly high mortality and morbidity, 6-9 the prevention of late TR is clinically important. In this regard, information regarding the incidence and predictors of progression or development of late TR is of substantial value for determining optimal operative timing and the surgical strategy to prevent late TR development, at the time of surgery for underlying left-sided valve disease. Several previous reports on this topic have been limited by a relatively small study population, 5,10 a short-term follow-up, 11 or the lack of reliable echocardiographic data. 12 Therefore, the present study was performed to investigate the incidence of late de novo TR develo...

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Section: Prevention Of Late Tr Developmentmentioning

confidence: 99%

Development of tricuspid regurgitation late after left-sided valve surgery: A single-center experience with long-term echocardiographic examinations

Kwak

Kim

et al. 2008

American Heart Journal

Self Cite

171

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“…[5][6][7][8] Surgical indications and types of surgery have been poorly described in patients undergoing TA, 3,4 and few clinical reports have evaluated patients' prognosis to determine the predictors of adverse outcome. Parameters such as laboratory testing, 9,10 New York Heart Association (NYHA) class, 10 and RV function 11 have been shown to be prognostic factors for these patients. However, the prognostic implications of RV echocardiography parameters have not been studied.…”

mentioning

confidence: 99%

Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty

et al. 2014

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Background-Patients who undergo tricuspid annuloplasty during left-side heart valve surgery have a poor postoperative clinical outcome. However, preoperative right ventricular (RV) echocardiography parameters that predict adverse events in these patients are poorly understood. Methods and Results-We studied 74 patients (age, 58±10 years; men, 27%) with significant tricuspid regurgitation who consequently underwent tricuspid annuloplasty during left-side heart valve surgery.

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“…Reduction in right ventricular function may also aggravate TR by inducing tricuspid annular dilatation and right ventricular remodeling. 12,13) Through diminished pumping ability it may also reduce the severity of pulmonary hypertension in some cases, and contribute to the complex role played by preoperative pulmonary hypertension as a predictor of worsening of TR. In our series rheumatic etiology, AF, MS and LAD ≥60 mm were identified as risk factors for failure of improvement in the nTAP group (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Which Type of Secondary Tricuspid Regurgitation Accompanying Mitral Valve Disease Should Be Surgically Treated?

Ariyoshi

Hashizume

Taniguchi³

et al. 2013

ATCS

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Purpose: The purpose of this study was to examine changes in severity of secondary tricuspid regurgitation (TR) accompanying mitral valve disease, and to identify factors predicting failure of improvement in TR after mitral valve surgery. Methods: We studied 99 patients who had TR of grade ≥2+ preoperatively, 47 with tricuspid annuloplasty (TAP Group) performed concurrently, and 52 with mitral surgery alone (nTAP Group). Predictors of failure of improvement in TR in the nTAP Group were analyzed. Results: The mean follow-up period was 4.6 ± 2.7 years. There was a significant difference between the TAP and nTAP Groups in TR improvement (93.6% vs. 67.3% respectively, p <0.001) and in change of TR grade (-2.1 ± 1.0 vs. -0.9 ± 1.0 respectively, p <0.001). Univariate analysis in the nTAP Group identified rheumatic etiology, atrial fibrillation, mitral stenosis (MS), and large left atrium prior to surgery as risk factors for failure of improvement. In multivariate analysis atrial fibrillation was identified as a predictor of failure of improvement (p = 0.004). Conclusion: Our results suggest that TAP should be performed concurrently with mitral valve surgery in patients with secondary TR of grade ≥2+, especially those having atrial fibrillation, even if TR is not severe.

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Prediction of Outcome in Patients Undergoing Surgery for Severe Tricuspid Regurgitation Following Mitral Valve Surgery and Role of Tricuspid Annular Systolic Velocity

Cited by 108 publications

References 14 publications

Development of tricuspid regurgitation late after left-sided valve surgery: A single-center experience with long-term echocardiographic examinations

Development of tricuspid regurgitation late after left-sided valve surgery: A single-center experience with long-term echocardiographic examinations

Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty

Which Type of Secondary Tricuspid Regurgitation Accompanying Mitral Valve Disease Should Be Surgically Treated?

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