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Does moderate tricuspid regurgitation require attention during mitral valve surgery?
Author(s) -
Yeates Alexander,
Marwick Thomas,
Deva Rajeev,
Mundy Julie,
Wood Annabelle,
Griffin Rayleene,
Peters Paul,
Shah Pallav
Publication year - 2013
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12068
Subject(s) - medicine , cardiology , tricuspid valve , regurgitation (circulation) , mitral regurgitation , surgery
Background This study aims to determine whether tricuspid regurgitation ( TR ) ≥ 2+ requires attention during mitral valve surgery. Methods From A pril 1999 to 2009, 161 patients undergoing primary, isolated mitral valve procedures were assessed. Preoperative moderate TR (≥2+) was present in 56 of 161 patients and tricuspid valve repair ( TVR : ring annuloplasty) was carried out on 22 of 56 patients with TR ≥ 2+. Baseline echocardiogram included TR severity ( ASE criteria), TR velocity, estimated right atrial pressure, visual assessment of right ventricular failure and strain. Follow‐up was 47 ± 33 months (96% complete); 91 of 161 patients overall (57%) and 44 of 45 patients with TR ≥ 2+ had follow‐up echocardiogram. Results Patients with moderate TR had worse baseline functional class and operative risks, both worst in the non‐ TVR group. Overall mortality was 15% ( n = 23), comprising 2.5% (4/161) 30‐day mortality and 12% (9/157) late death. Poorer preoperative TR was associated with worse survival by univariate analysis ( P = 0.046), after correction for right ventricular function and pulmonary artery pressure ( P = 0.049), age and diabetes ( P = 0.041). Despite lower risk of TR ≥ 2+ with TVR , 5‐year survival was 42%, which was less than TR < 2+ and that of non‐ TVR group (90%, P = 0.003). Improvement in overall functional class ( NYHA ) was better in the non‐ TVR group ( TVR : preoperative 2.1 ± 1.5; post‐operative 1.2 ± 1.1 ( P = 0.02) versus non‐ TVR : preoperative 1.8 ± 1.4, post‐operative 1.2 ± 0.9 ( P < 0.0001)). There was no difference in quality of life ( QOL) indices ( SF ‐36 questionnaire) at follow‐up between patients with TR < 2+ and TR ≥ 2+ preoperatively, or across all levels of TR before or after surgical repair. Conclusions Preoperative TR ≥ 2+, non‐ TVR group had more favourable functional class and mid‐term survival with comparable QOL and echocardiographic parameters to the TVR group.