Valvular heart disease
Prediction of Outcome in Patients Undergoing Surgery for Severe Tricuspid Regurgitation Following Mitral Valve Surgery and Role of Tricuspid Annular Systolic Velocity

https://doi.org/10.1016/j.amjcard.2006.03.047Get rights and content

This study was performed to identify echocardiographic parameters related to postoperative clinical outcome in patients who undergo surgery for severe tricuspid regurgitation after mitral valve surgery. Eighteen patients (2 men, 16 women; mean age 58 years) were prospectively enrolled. Echocardiographic examinations were performed before and 15 ± 7 months after surgery. Favorable postoperative clinical outcome was defined as an improvement of ≥1 in New York Heart Association functional class or a >25% increase in respiratory variation of inferior vena cava diameter. Operative mortality was 11% (2 of 18). Of the 16 survivors, 9 (56%) achieved favorable postoperative clinical outcomes. Only systolic tricuspid annulus velocity (S′T) was found to be associated with postoperative clinical outcome (favorable vs unfavorable postoperative clinical outcome 12.9 ± 2.1 vs 9.7 ± 1.7 cm/s, p <0.05). For S′T <9.5 cm/s, the sensitivity, specificity, and positive and negative predictive values for predicting an unfavorable postoperative clinical outcome were 67%, 100%, 100%, and 75%, respectively. In conclusion, ST′ can predict postoperative clinical outcomes in these patients.

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Study subjects

Eighteen patients with severe TR after mitral valve surgery who underwent surgical correction for TR without concomitant mitral or aortic valve surgery from January 2003 to January 2005 were prospectively enrolled. The mean age was 58 ± 5 years, and 2 patients (11%) were men. The cause of TR in all patients was functional after mitral surgery.

Echocardiographic examination

Before surgery, comprehensive echocardiographic examinations were performed using an Acuson Sequoia (Siemens Medical Solutions USA, Inc., Mountain View,

Patient characteristics and clinical outcomes

The baseline characteristics of patients are listed in Table 1. Two in-hospital deaths occurred (25%), 1 due to right ventricular failure and the other due to sepsis, probably associated with a prolonged indwelling catheter. At follow-up evaluation, 9 patients of 16 survivors showed favorable postoperative clinical outcomes. Among patients with favorable postoperative clinical outcomes, 2 were in NYHA functional class II, 4 were in class III, and 3 were in class IV. Among those with unfavorable

Discussion

Previous studies have shown that concomitant coronary artery disease,5, 6 NYHA functional class,5, 6, 7, 8, 9 previous cardiac surgery,4, 8 symptoms and signs of congestive heart failure,5, 8, 9, 10 male gender,8, 9, 10 and the presence of primary lung disease6 are associated with poor prognoses for those who undergo the surgical correction of TR. In the present study, all patients had undergone previous mitral valve surgery, and no patients had concomitant coronary or lung disease; therefore,

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    However, the present results demonstrate that TV annuloplasty was effective in preventing the development of significant TR, which is an independent predictor of worse survival in general4 and after MV surgery. Because TV annuloplasty in patients with a dilated TV annulus is not associated with incremental risk of mortality, and reoperation of late significant TR is associated with high morbidity and mortality,5 a more widespread use of preventive TV annuloplasty might be justifiable. Large prospective studies are needed to clarify the clinical benefit of preventive TV annuloplasty during MV surgery and to establish selection criteria for patients who may benefit most from preventive TV annuloplasty.

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