Philippe B Bertrand1, Gille Koppers2, Frederik H Verbrugge3, Wilfried Mullens3, Pieter Vandervoort3, Robert Dion4, David Verhaert5. 1. Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. Electronic address: philippe.bertrand@zol.be. 2. Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. 3. Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium. 4. Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium. 5. Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Abstract
OBJECTIVES: Tricuspid valve annuloplasty (TVP) has been advocated concomitantly with left-sided cardiac surgery in case of more than moderate tricuspid regurgitation (TR) or tricuspid annular dilation (TAD) (diameter >40 mm or 21 mm/m²) even in the absence of significant TR. Data on postoperative right ventricular (RV) remodeling are lacking in such patients. METHODS: Preoperative and postoperative echocardiography data from 45 consecutive TVP procedures, performed in mitral valve surgery in a single tertiary center, were retrospectively analyzed and compared with a propensity-matched control group of 33 procedures without concomitant TVP. RV function and geometry was analyzed by measuring RV size, fractional area change, and end-diastolic sphericity index (RVSI = long-axis length/short-axis width) and compared at baseline versus follow-up. RESULTS: At a mean follow-up of 5 months, a favorable change in RV geometry was observed in TVP patients (RVSI increased from 1.99 ± 0.33 to 2.21 ± 0.42; P = .001), whereas the opposite was observed in the control group (RVSI decreased from 2.34 ± 0.52 to 2.17 ± 0.13; P = .05). Only in control patients, indexed RV end-diastolic area increased significantly (P = .003). In TVP patients, when comparing patients with baseline more than moderate TR (n = 13) to patients with isolated TAD (n = 32), there was a significant decrease in RV end-diastolic area only in the group with more than moderate TR (from 12.9 ± 3.5 cm(2)/m(2) to 10.3 ± 1.9 cm(2)/m(2); P = .009). CONCLUSIONS: Adding TVP to mitral valve surgery in patients with more than moderate TR or TAD leads to favorable changes in RV geometry and prevents postoperative RV dilation. This is most pronounced in patients with more than moderate TR at baseline.
OBJECTIVES:Tricuspid valve annuloplasty (TVP) has been advocated concomitantly with left-sided cardiac surgery in case of more than moderate tricuspid regurgitation (TR) or tricuspid annular dilation (TAD) (diameter >40 mm or 21 mm/m²) even in the absence of significant TR. Data on postoperative right ventricular (RV) remodeling are lacking in such patients. METHODS: Preoperative and postoperative echocardiography data from 45 consecutive TVP procedures, performed in mitral valve surgery in a single tertiary center, were retrospectively analyzed and compared with a propensity-matched control group of 33 procedures without concomitant TVP. RV function and geometry was analyzed by measuring RV size, fractional area change, and end-diastolic sphericity index (RVSI = long-axis length/short-axis width) and compared at baseline versus follow-up. RESULTS: At a mean follow-up of 5 months, a favorable change in RV geometry was observed in TVPpatients (RVSI increased from 1.99 ± 0.33 to 2.21 ± 0.42; P = .001), whereas the opposite was observed in the control group (RVSI decreased from 2.34 ± 0.52 to 2.17 ± 0.13; P = .05). Only in control patients, indexed RV end-diastolic area increased significantly (P = .003). In TVPpatients, when comparing patients with baseline more than moderate TR (n = 13) to patients with isolated TAD (n = 32), there was a significant decrease in RV end-diastolic area only in the group with more than moderate TR (from 12.9 ± 3.5 cm(2)/m(2) to 10.3 ± 1.9 cm(2)/m(2); P = .009). CONCLUSIONS: Adding TVP to mitral valve surgery in patients with more than moderate TR or TAD leads to favorable changes in RV geometry and prevents postoperative RV dilation. This is most pronounced in patients with more than moderate TR at baseline.
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: Alexander A Brescia; Sarah T Ward; Tessa M F Watt; Liza M Rosenbloom; Megan Baker; Shazli Khan; Emilie Ziese; Matthew A Romano; Steven F Bolling Journal: Ann Thorac Surg Date: 2019-08-31 Impact factor: 4.330