Acquired cardiovascular disease
Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure

https://doi.org/10.1016/j.jtcvs.2012.08.061Get rights and content
Under an Elsevier user license
open archive

Objectives

To study the effect of mitral valve repair with or without concomitant tricuspid valve repair on functional tricuspid regurgitation and right ventricular function.

Methods

From 2001 to 2007, 1833 patients with degenerative mitral valve disease, a structurally normal tricuspid valve, and no coronary artery disease underwent mitral valve repair, and 67 underwent concomitant tricuspid valve repair. Right ventricular function (myocardial performance index and tricuspid annular plane systolic excursion) was measured before and after surgery using transthoracic echocardiography for randomly selected patients with tricuspid regurgitation grade 0, 1+, and 2+ (100 patients for each grade) and 93 with grade 3+/4+, 393 patients in total.

Results

In patients with mild (<3+) preoperative tricuspid regurgitation, mitral valve repair alone was associated with reduced tricuspid regurgitation and mild worsening of right ventricular function. Tricuspid regurgitation of 2+ or greater developed in fewer than 20%, and right ventricular function had improved, but not to preoperative levels, at 3 years. In patients with severe (3+/4+) preoperative tricuspid regurgitation, mitral valve repair alone reduced tricuspid regurgitation and improved right ventricular function; however, tricuspid regurgitation of 2+ or greater returned and right ventricular function worsened toward preoperative levels within 3 years. Concomitant tricuspid valve repair effectively eliminated severe tricuspid regurgitation and improved right ventricular function. Also, over time, tricuspid regurgitation did not return and right ventricular function continued to improve to levels comparable to that of patients with lower grades of preoperative tricuspid regurgitation.

Conclusions

In patients with mitral valve disease and severe tricuspid regurgitation, mitral valve repair alone was associated with improved tricuspid regurgitation and right ventricular function. However, the improvements were incomplete and temporary. In contrast, concomitant tricuspid valve repair effectively and durably eliminated severe tricuspid regurgitation and improved right ventricular function toward normal, supporting an aggressive approach to important functional tricuspid regurgitation.

Abbreviations and Acronyms

MPI
myocardial performance index
MR
mitral regurgitation
MVR
mitral valve repair
RV
right ventricular
TAPSE
tricuspid annular plane systolic excursion
TR
tricuspid regurgitation
TTE
transthoracic echocardiogram
TV
tricuspid valve
TVR
tricuspid valve repair

CTSNet classification

35

Cited by (0)

This study was supported in part by the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (to Dr Blackstone), and the Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research, James and Sharon Kennedy, the Slosburg Family Charitable Trust, Stephen and Saundra Spencer, and Martin Nielsen (to Dr Pettersson).

Disclosures: Authors have nothing to disclose with regard to commercial support.