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

Abstract

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.

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

“…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.…”

“…Eight studies [17,18,20,21,22,25,26,27] were combined to get a pooled OR of 4.54 (95% CI 3.44-5.99), and with the data from the multivariate analyses reported in 4 of the articles, the adjusted pooled OR remained robust at 3.70 (95% CI 2.51-5.46). Several reports have highlighted the potential of preoperative AF to be a determinant of TR progression by showing the beneficial effect of a concomitant maze procedure for the prevention of residual TR [18,28,33].…”

Predictive factor of secondary tricuspid regurgitation after aortic valve replacement for aortic stenosis: the importance of myocardial hypertrophy and diastolic dysfunction

“…There are several reports in the literature on surgical indication, risk factors, and prognosis in secondary tricuspid regurgitation (STR) complicated with left-sided valve disease [1][2][3]. The development of moderate or greater than moderate STR after left-sided valve surgery worsens the long-term prognosis [2,4].…”

“…The development of moderate or greater than moderate STR after left-sided valve surgery worsens the long-term prognosis [2,4]. In previous studies, female [5][6][7], mitral stenosis [1], rheumatic etiology [1,6], atrial fibrillation [1,4,6,7], low left ventricular (LV) function [7], dilatation of the left atrium [1,4,5], pulmonary hypertension [5,7], dilatation of the right ventricle [8], preoperative TR severity [4], tricuspid valve (TV) annular dilatation [9], and TV tethering [10] were reported as predictors of STR; however, most of these reports were of patients with mitral valve disease. Although STR complicated with aortic stenosis (AS) is not uncommon [4], there is a lack of information on late STR that has developed after aortic valve replacement (AVR) for AS.…”

Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair

“…It was historically believed that TR may improve after correction of the MV pathology [ 4 ]. However, recent data have shown an increase in TR in a still unclassified subgroup, irrespective of residual or recurrence of MV disease or preoperative TR [ 5 – 8 ]. Reoperation may be associated with high mortality [ 9 ].…”