Predictors of secondary tricuspid regurgitation after left-sided valve replacement

Wang, Guohua; Sun, Zhen; Xia, Jia-hong; Deng, Yongzhi; Chen, Jiajun; Su, Gang; Ke, Youli

doi:10.1007/s00595-007-3721-3

Cited by 43 publications

(46 citation statements)

References 17 publications

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“…The predictive role of left atrium size in FTR progression following MVR was well described by previous retrospective studies (13,28,29). In our study, the left atrium diameter was found to be significantly different both preoperative and postoperatively between groups.…”

Section: Discussionsupporting

confidence: 79%

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Long-term prognosis of mild functional tricuspid regurgitation after mitral valve replacement: an observational retrospective study

Gürsoy¹,

Bakuy²,

Hatemi³

et al. 2013

Anadolu Kardiyol Derg

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Objective: Functional tricuspid regurgitation (FTR) is the most common type of tricuspid insufficiency and occurs approximately in 30% of patients with mitral valve disease. The major etiologic factor in the triggering of right ventricular dilation and thus causing functional tricuspid regurgitation, is pulmonary artery hypertension secondary to mitral valve disease. We aimed to analyze long-term outcomes of patients with mild tricuspid regurgitation at the time of mitral valve replacement. Methods: Sixty-six patients with mild tricuspid insufficiency who underwent mitral valve replacement were included in this observational retrospective study. Mean follow-up time was 8.3±0.7 years. Patients whose tricuspid regurgitation remained unchanged or decreased following operation were enrolled to group 1 (n=32), patients whose tricuspid regurgitation increased were included to group 2 (n=34) and data were compared statistically with t-test, Mann-Whitney U, Chi-square and Fisher Exact test. Multiple regression analysis was performed to determine independent risk factors for FTR progression. Results: Preoperatively female gender (p=0.02), body surface area (p=0.04), left atrium diameter (p=0.01), functional capacity (p=0.03), right ventricle diameter (p=0.04), and left ventricle mass index (p=0.04) were found to be statistically significant between groups. In the follow-up; functional capacity, grade of tricuspid insufficiency, pulmonary artery pressure, vena contracta width (p<0.001), TAPSE (tricuspid annular plane systolic excursion index) (p=0.04), annulus diameter (p=0.02), right ventricle diameter (p=0.01), left ventricle mass index (p=0.05), and ejection fraction (p=0.02) were found to be statistically different between groups. In multiple logistic regression analysis; preoperative LA diameter (OR=5.05; 95% CI:1.49-17.12; p=0.009) and female gender (OR=10.93; 95% CI:1.77-67.31; p=0.01) were found as independent risk factors for FTR progression. Conclusion: This study revealed that mild FTR might advance to moderate to severe grade in more than half of the patients in the follow-up. Thus, surgical approach to even mild FTR should be individualized based on patient's risk assessment. (Anadolu Kardiyol Derg 2014; 14: 34-9)

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Section: Discussionsupporting

confidence: 79%

“…Preoperative ejection fraction was not shown as a risk factor for FTR but almost all studies as well as ours also investigated patients with normal or mildly decreased ejection fraction (1,13,28,29). Therefore, we believe that more studies are required to evaluate patients with moderate or severe left ventricular dysfunction.…”

Section: Discussionmentioning

confidence: 73%

Long-term prognosis of mild functional tricuspid regurgitation after mitral valve replacement: an observational retrospective study

Gürsoy¹,

Bakuy²,

Hatemi³

et al. 2013

Anadolu Kardiyol Derg

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“…Thirty-six studies were potentially eligible and after being full-text screened, 11 publications [17,18,19,20,21,22,23,24,25,26,27] were eligible for our meta-analysis. The characteristics of these 11 studies are listed in table 1.…”

Section: Resultsmentioning

confidence: 99%

“…In our study, we found a strong association of rheumatic etiology with residual TR (OR 3.22, 95% CI 2.19-4.75). The time from onset to surgery was reported to be an independent risk factor for late TR in only 1 Chinese study [21]. A long disease course and iterative left-sided valve diseases that have not been corrected in time can lead to increased left atrial size and pressure, secondary pulmonary hypertension and consequent RV remodeling and dysfunction, eventually leading to progression of late TR.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Risk Factors for Residual Tricuspid Regurgitation after Isolated Left-Sided Valve Surgery: A Systematic Review and Meta-Analysis

et al. 2014

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Objectives: Residual tricuspid regurgitation (TR) that has developed after isolated left-sided valve surgery is not uncommon. Indications for concomitant tricuspid repair at the initial operation have not been well established. The selection of high-risk preoperative patients is of great importance in this situation. Methods: Six databases were searched to access eligible articles reporting potential risk factors for the development of residual TR. The pooled analysis of risk factors was based on odds ratios or mean differences with their 95% confidence intervals. Results: A total of 3,138 patients with 487 residual TR in 11 studies were analyzed. Of the 14 candidate parameters in our meta-analysis, 10 factors, i.e. older age, female gender, atrial fibrillation, rheumatic etiology, mitral valve surgery, previous valve surgery, a long time from onset to surgery, 2+/3+ TR and enlarged left and right atria, were found to be significantly associated with the development of residual TR. Conclusions: Our study highlights the role of the above preoperative risk factors in the development of residual TR after isolated left-sided valve surgery and emphasizes the need of further studies to investigate other potential predictors. Moreover, predictive models or scoring systems for the identification of patients at a high risk for developing late TR are urgently needed.

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“…Indeed, in our data the E/E' ratio, which reflects LA factors in late TR after left-side cardiac surgery. 22- 25 Kim et al found that AF predisposed patients undergoing mitral valve surgery to late TR progression, which could be prevented by the maze operation. 26 In addition, they showed that the absence of RA mechanical activity was a predictor for progression of late TR in a subgroup analysis of 38 patients who had 1/128 vs. 2/83; P=0.563).…”

Section: Beneficial Effect Of La Activity On Long-term Outcomesmentioning

confidence: 99%

Effect of Left Atrial Activity After the Maze Procedure on Clinical and Echocardiographic Outcomes

Park

Kim

et al. 2014

Circ J

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Predictors of secondary tricuspid regurgitation after left-sided valve replacement

Abstract: An aggressive repair of accompanying TR should be performed at the time of initial surgery in patients with a huge left atrium, atrial fibrillation, long time from onset to surgery, or tricuspid rheumatic changes. DeVega's tricuspid annuloplasty therefore helps prevent a progression of TR.

Cited by 43 publications

References 17 publications

Long-term prognosis of mild functional tricuspid regurgitation after mitral valve replacement: an observational retrospective study

Long-term prognosis of mild functional tricuspid regurgitation after mitral valve replacement: an observational retrospective study

Preoperative Risk Factors for Residual Tricuspid Regurgitation after Isolated Left-Sided Valve Surgery: A Systematic Review and Meta-Analysis

Effect of Left Atrial Activity After the Maze Procedure on Clinical and Echocardiographic Outcomes

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