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Determinants of recurrent tricuspid regurgitation following tricuspid valve annuloplasty during mitral valve surgery
Author(s) -
Ito Hisato,
Mizumoto Toru,
Sawada Yasuhiro,
Fujinaga Kazuya,
Tempaku Hironori,
Shimpo Hideto
Publication year - 2017
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13117
Subject(s) - medicine , atrial fibrillation , sinus rhythm , cardiology , hazard ratio , tricuspid valve , mitral valve , regurgitation (circulation) , mitral regurgitation , mitral valve repair , concomitant , surgery , tricuspid valve insufficiency , confidence interval
Background The purpose of this study was to determine risk predictors for recurrent tricuspid regurgitation (TR) following tricuspid valve annuloplasty during mitral valve surgery. Methods Ninety‐eight consecutive patients underwent tricuspid valve annuloplasty concomitant with mitral valve repair (71 patients), replacement (16 patients), or other procedures over a 10‐year period. Fifty‐seven patients underwent surgery with a flexible band and 41 with a rigid ring. Results Late TR progression (≥2/4) occurred in eight (14.0%) of flexible band patients, and in nine (22.0%) rigid ring patients. Multivariate analysis did not identify the superiority of one annuloplasty device over the other to prevent recurrent TR. Multivariate risk predictors of late TR progression were late atrial fibrillation (hazard ratio [HR]: 3.78; 95% confidence interval [CI]: 1.19‐12.0), and recurrent mitral regurgitation; HR; 4.46; 95%CI; 1.52‐13.1). Freedom from TR progression at 5 years was 89.2% in atrial fibrillation‐free patients compared to 56.8% in those with atrial fibrillation (log‐rank, P = 0.018), and 89.8% in mitral regurgitation‐free patients compared to 55.3% in those with recurrent mitral regurgitation (log‐rank, P = 0.003). Conclusions A durable mitral valve repair and preservation of sinus rhythm are the keys to preventing late TR progression.