Heemoon Lee1, Kiick Sung1, Wook Sung Kim1, Young Tak Lee1, Sung-Ji Park2, Keumhee Chough Carriere3, Pyo Won Park4. 1. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3. Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada; Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 4. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: pwpark@skku.edu.
Abstract
OBJECTIVE: The aim of this study was to evaluate the long-term clinical and hemodynamic influences of prophylactic tricuspid annuloplasty (TAP) in patients with less-than-moderate tricuspid regurgitation (TR) who underwent mitral valve replacement (MVR). METHODS: Between November 1994 and December 2010, 293 patients with less-than-moderate TR who underwent primary mechanical MVR were categorized into 2 groups: TAP (n = 151) or no TAP (n = 142). The median age was 51 years (quartile (Q)1-Q3, 43-59 years). The cause of valve pathology was rheumatic in 92.5% of patients (n = 271). The prevalence of preoperative atrial fibrillation was in 73.0%. Using propensity score matching based on demographic information, 91 TAP patients could be matched to 91 no TAP patients. Median follow-up duration was 107 months (Q1-Q3, 76-162 months). RESULTS: There was no early mortality in either group. Early morbidities, including heart block were not different between groups. Although overall survival and freedom from cardiac-related mortality did not differ between groups (P = .519 and P = .115, respectively), freedom from recurrence of moderate or higher TR grade were significantly higher in the TAP group (P = .043). In subgroup analyses, these group differences of TAP were especially prominent in patients with sinus rhythm compared with patients with atrial fibrillation at discharge (P = .047 vs P = .460). CONCLUSIONS: Prophylactic TAP for patients with less-than-moderate TR grade who underwent mechanical MVR can prevent late TR progression without increasing early surgical risks. Longer-term follow-up is required to determine the clinical beneficial effect of prophylactic TAP.
OBJECTIVE: The aim of this study was to evaluate the long-term clinical and hemodynamic influences of prophylactic tricuspid annuloplasty (TAP) in patients with less-than-moderate tricuspid regurgitation (TR) who underwent mitral valve replacement (MVR). METHODS: Between November 1994 and December 2010, 293 patients with less-than-moderate TR who underwent primary mechanical MVR were categorized into 2 groups: TAP (n = 151) or no TAP (n = 142). The median age was 51 years (quartile (Q)1-Q3, 43-59 years). The cause of valve pathology was rheumatic in 92.5% of patients (n = 271). The prevalence of preoperative atrial fibrillation was in 73.0%. Using propensity score matching based on demographic information, 91 TAP patients could be matched to 91 no TAP patients. Median follow-up duration was 107 months (Q1-Q3, 76-162 months). RESULTS: There was no early mortality in either group. Early morbidities, including heart block were not different between groups. Although overall survival and freedom from cardiac-related mortality did not differ between groups (P = .519 and P = .115, respectively), freedom from recurrence of moderate or higher TR grade were significantly higher in the TAP group (P = .043). In subgroup analyses, these group differences of TAP were especially prominent in patients with sinus rhythm compared with patients with atrial fibrillation at discharge (P = .047 vs P = .460). CONCLUSIONS: Prophylactic TAP for patients with less-than-moderate TR grade who underwent mechanical MVR can prevent late TR progression without increasing early surgical risks. Longer-term follow-up is required to determine the clinical beneficial effect of prophylactic TAP.
Authors: Jae Woong Choi; Kyung Hwan Kim; Su Chan Lim; Sue Hyun Kim; Suk Ho Sohn; Yeiwon Lee; Ho Young Hwang Journal: Korean J Thorac Cardiovasc Surg Date: 2020-12-05
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