BACKGROUND: Uncertainty about long-term effects of surgically unaddressed moderate (2+) secondary tricuspid valve (TV) regurgitation (TR) accompanying left-sided degenerative heart valve disease led us to identify reasons for and factors associated with TV repair, compare safety and clinical effectiveness of relieving TR, and identify factors associated with severe (3/4+) postoperative TR. METHODS: From 1997 to 2008, 1,724 patients with 2+ TR underwent 830 mitral, 703 aortic, and 191 double-valve procedures; 91 (5%) had concomitant TV repair. Logistic regression analysis was used to identify factors associated with TV repair and for propensity-matched comparison of safety (in-hospital morbidity, mortality) and effectiveness of TV repair (longitudinal echocardiographic assessment of postoperative TR and New York Heart Association class, TV intervention, survival). RESULTS: Factors associated with TV repair of 2+ TR included larger right ventricles and left ventricles (p<0.001), greater TV tethering height (p=0.0002), and prior concurrent mitral valve procedures (p≤0.004). In-hospital complications, subsequent TV interventions, and intermediate-term survival were similar for matched patients. The TV repair patients had less 3/4+ TR at discharge (7% versus 15%), sustained out to 3 years. No TV repair (p=0.05), female sex (p<0.0001), and mitral valve replacement (p=0.008) were associated with 3/4+ TR. CONCLUSIONS: A TV repair for moderate TR concomitant with surgery for degenerative left-sided heart valve disease is reasonable to provide an opportunity to prevent its progression and development of right ventricle dysfunction, particularly for patients with important right ventricle remodeling and evidence of right ventricular failure, and for patients with advanced left-sided disease requiring mitral valve replacement.
BACKGROUND: Uncertainty about long-term effects of surgically unaddressed moderate (2+) secondary tricuspid valve (TV) regurgitation (TR) accompanying left-sided degenerative heart valve disease led us to identify reasons for and factors associated with TV repair, compare safety and clinical effectiveness of relieving TR, and identify factors associated with severe (3/4+) postoperative TR. METHODS: From 1997 to 2008, 1,724 patients with 2+ TR underwent 830 mitral, 703 aortic, and 191 double-valve procedures; 91 (5%) had concomitant TV repair. Logistic regression analysis was used to identify factors associated with TV repair and for propensity-matched comparison of safety (in-hospital morbidity, mortality) and effectiveness of TV repair (longitudinal echocardiographic assessment of postoperative TR and New York Heart Association class, TV intervention, survival). RESULTS: Factors associated with TV repair of 2+ TR included larger right ventricles and left ventricles (p<0.001), greater TV tethering height (p=0.0002), and prior concurrent mitral valve procedures (p≤0.004). In-hospital complications, subsequent TV interventions, and intermediate-term survival were similar for matched patients. The TV repair patients had less 3/4+ TR at discharge (7% versus 15%), sustained out to 3 years. No TV repair (p=0.05), female sex (p<0.0001), and mitral valve replacement (p=0.008) were associated with 3/4+ TR. CONCLUSIONS: A TV repair for moderate TR concomitant with surgery for degenerative left-sided heart valve disease is reasonable to provide an opportunity to prevent its progression and development of right ventricle dysfunction, particularly for patients with important right ventricle remodeling and evidence of right ventricular failure, and for patients with advanced left-sided disease requiring mitral valve replacement.
Authors: Sylvia Otto; Marija Velichkov; Ali Hamadanchi; P Christian Schulze; Sven Moebius-Winkler Journal: Cardiol J Date: 2021-05-04 Impact factor: 2.737
Authors: James S Gammie; Michael W A Chu; Volkmar Falk; Jessica R Overbey; Alan J Moskowitz; Marc Gillinov; Michael J Mack; Pierre Voisine; Markus Krane; Babatunde Yerokun; Michael E Bowdish; Lenard Conradi; Steven F Bolling; Marissa A Miller; Wendy C Taddei-Peters; Neal O Jeffries; Michael K Parides; Richard Weisel; Mariell Jessup; Eric A Rose; John C Mullen; Samantha Raymond; Ellen G Moquete; Karen O'Sullivan; Mary E Marks; Alexander Iribarne; Friedhelm Beyersdorf; Michael A Borger; Arnar Geirsson; Emilia Bagiella; Judy Hung; Annetine C Gelijns; Patrick T O'Gara; Gorav Ailawadi Journal: N Engl J Med Date: 2021-11-13 Impact factor: 91.245
Authors: Brian J Kelly; Jamahal Maeng Ho Luxford; Carolyn Goldberg Butler; Chuan-Chin Huang; Kerry Wilusz; Julius I Ejiofor; James D Rawn; John A Fox; Stanton K Shernan; Jochen Daniel Muehlschlegel Journal: J Thorac Cardiovasc Surg Date: 2017-11-08 Impact factor: 5.209