Tricuspid Valve Tethering Predicts Residual Tricuspid Regurgitation After Tricuspid Annuloplasty

Fukuda, Shota; Song, Jong–Min; Gillinov, A. Marc; McCarthy, Patrick M.; Daimon, Masao; Kongsaerepong, Vorachai; Thomas, James D.; Shiota, Takahiro

doi:10.1161/01.cir.0000156449.49998.51

Cited by 307 publications

(178 citation statements)

References 27 publications

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“…Although preoperative TR severity and tricuspid annular dimension usually serve as a guide as to whether tricuspid valve annuloplasty is indicated, 20 tricuspid annuloplasty is adamantly unsuccessful in a substantial number of patients. 21 Our findings as is do not provide mechanistic insights into the determinants of late TR. The association with atrial fibrillation may be due to the fact that atrial fibrillation reflects a more advanced underlying valve disease.…”

Section: Prevention Of Late Tr Developmentmentioning

confidence: 70%

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

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: 70%

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

171

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“…RV contractility was also evaluated by using the peak systolic tissue velocity of the RV lateral wall assessed at the tricuspid annulus. Second, measurements of the TV annulus diameter were performed at the time of the maximum TV diastolic opening between the 2 hinge points at the junction between the valvular leaflets and the TV annulus 25, 26, 27. Finally, the distance and area of TV tethering were measured by tracing between the atrial surface of the leaflets and the tricuspid annular plane at the time of maximal systolic closure.…”

Section: Methodsmentioning

confidence: 99%

Prevalence, Predictors, and Prognostic Value of Residual Tricuspid Regurgitation in Patients With Left Ventricular Assist Device

Nakanishi

Homma

Han

et al. 2018

JAHA

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BackgroundAlthough implantation of a left ventricular assist device (LVAD) generally improves tricuspid regurgitation (TR) in short‐term follow‐up, the clinical significance of residual TR in patients with mid‐ to long‐term LVAD support is unknown. This study aimed to identify the prevalence, predictors, and prognostic value of residual TR in LVAD patients in association with tricuspid valve (TV) deformation.Methods and ResultsThe study cohort consisted of 127 patients who underwent LVAD implantation without TV procedure and were supported with LVAD at least 1 year. All patients underwent echocardiographic examination preoperatively and 1 year after LVAD implantation. TR was quantitatively assessed by ratio of TR color jet area/right atrial area, and significant residual TR was defined as ≥20% of %TR at follow‐up echocardiographic examination. Detailed echocardiographic measurements were also performed, including TV annulus diameter, TV leaflet displacement, and left ventricular and right ventricular systolic function. LVAD implantation significantly improved ratio of TR color jet area/right atrial area as well as left ventricular and right ventricular systolic function and tethering distance (all P<0.05), whereas it enlarged TV annulus diameter (P=0.002). Significant residual TR was observed in 30 (23.6%) patients. Age, preoperative TV annulus diameter, and residual mitral regurgitation were significantly associated with significant residual TR (all P<0.05), whereas TV tethering was not. During a mean follow‐up of 21±17 months, patients with residual TR had significantly higher mortality than those without residual TR (log‐rank P<0.001).ConclusionsSignificant residual TR was observed in ≈25% patients supported with LVAD over 1 year and was associated with unfavorable outcome.

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“…In patients undergoing concomitant TR repair at the time of mitral surgery, persistent severe TR is still present in 11% at 3 months, and 17% at 5 years (42). Predictors for residual regurgitation after surgical repair have been identified: higher pre-operative TR severity, higher pulmonary artery pressures, mitral replacement rather than repair, worse left ventricular dysfunction and presence of pacemaker leads through the valve area (43). Tricuspid valve morphology may also predict recurrence; tenting height, tenting area (43) and tenting volume (44) are predictors of residual TR following annuloplasty.…”

Section: How Can We Reproducibly Determine the Severity Of Tricuspid mentioning

confidence: 99%

“…Predictors for residual regurgitation after surgical repair have been identified: higher pre-operative TR severity, higher pulmonary artery pressures, mitral replacement rather than repair, worse left ventricular dysfunction and presence of pacemaker leads through the valve area (43). Tricuspid valve morphology may also predict recurrence; tenting height, tenting area (43) and tenting volume (44) are predictors of residual TR following annuloplasty. The current guidelines use a 2D echocardiographic annular measurement to guide intervention (6,9).…”

Section: How Can We Reproducibly Determine the Severity Of Tricuspid mentioning

confidence: 99%

Current transcatheter devices to treat functional tricuspid regurgitation with discussion of issues relevant to clinical trial design

Hahn

2017

Ann. Cardiothorac. Surg.

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Functional or secondary tricuspid regurgitation (TR) has seen increased attention in recent times as relationships with clinically-relevant outcomes have come to light. Despite the association of increased mortality with significant TR, the disease remains under-recognized and thus relatively untreated. In addition, the disease itself has not been extensively studied and the interactions between annular dilatation, right heart disease and pulmonary hypertension are poorly understood. However, the high mortality and recurrence rate with current surgical replacement or repair techniques is well recognised, opening the door to transcatheter therapies for functional TR. The current perspective reviews the rationale for transcatheter solutions, describes some of the current approaches and discusses the ongoing questions of a poorly-studied condition which may limit the design of clinical trials for this disease.

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Tricuspid Valve Tethering Predicts Residual Tricuspid Regurgitation After Tricuspid Annuloplasty

Cited by 307 publications

References 27 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

Prevalence, Predictors, and Prognostic Value of Residual Tricuspid Regurgitation in Patients With Left Ventricular Assist Device

Current transcatheter devices to treat functional tricuspid regurgitation with discussion of issues relevant to clinical trial design

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