James S Gammie1, Michael W A Chu1, Volkmar Falk1, Jessica R Overbey1, Alan J Moskowitz1, Marc Gillinov1, Michael J Mack1, Pierre Voisine1, Markus Krane1, Babatunde Yerokun1, Michael E Bowdish1, Lenard Conradi1, Steven F Bolling1, Marissa A Miller1, Wendy C Taddei-Peters1, Neal O Jeffries1, Michael K Parides1, Richard Weisel1, Mariell Jessup1, Eric A Rose1, John C Mullen1, Samantha Raymond1, Ellen G Moquete1, Karen O'Sullivan1, Mary E Marks1, Alexander Iribarne1, Friedhelm Beyersdorf1, Michael A Borger1, Arnar Geirsson1, Emilia Bagiella1, Judy Hung1, Annetine C Gelijns1, Patrick T O'Gara1, Gorav Ailawadi1. 1. From the Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore (J.S.G.), and the Division of Cardiovascular Sciences (M.A.M., W.C.T.-P.), National Heart, Lung, and Blood Institute (N.O.J.), National Institutes of Health, Bethesda - both in Maryland; the Division of Cardiac Surgery, Western University, London Health Sciences Centre, London, ON (M.W.A.C.), and the Division of Cardiovascular Surgery, Toronto General Hospital and University of Toronto, Toronto (R.W.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC (P.V.), and Cardiovascular and Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton (J.C.M.) - all in Canada; the Department of Cardiothoracic and Vascular Surgery, Deutsche Herzzentrum Berlin, the Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, and DZHK (German Center for Cardiovascular Research), Berlin (V.F.), Technical University of Munich, School of Medicine and Health, the Department of Cardiovascular Surgery, Institute Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, and DZHK, Munich (M.K.), the Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg (L.C.), the Department of Cardiovascular Surgery, University Heart Center Freiburg, and Albert Ludwigs University Freiburg, Freiburg (F.B.), and Leipzig Heart Center, University of Leipzig, Leipzig (M.A.B.) - all in Germany; the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai (J.R.O., A.J.M., E.A.R., S.R., E.G.M., K.O., M.E.M., E.B., A.C.G.) and the Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine (M.K.P.) - both in New York; the Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland (M.G.); the Department of Cardiac and Thoracic Surgery, Baylor Scott and White Health, Plano (M.J.M.), and American Heart Association, Dallas (M.J.) - both in Texas; the Department of Surgery, Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT (A.G., M.K.); the Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, NC (B.Y.); the Departments of Surgery and Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles (M.E.B.); the Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor (S.F.B., G.A.); the Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (A.I.); and the Division of Cardiology, Massachusetts General Hospital (J.H.) and the Division of Cardiovascular Medicine, Brigham and Women's Hospital (P.T.O.) - both in Boston.
Abstract
BACKGROUND: Tricuspid regurgitation is common in patients with severe degenerative mitral regurgitation. However, the evidence base is insufficient to inform a decision about whether to perform tricuspid-valve repair during mitral-valve surgery in patients who have moderate tricuspid regurgitation or less-than-moderate regurgitation with annular dilatation. METHODS: We randomly assigned 401 patients who were undergoing mitral-valve surgery for degenerative mitral regurgitation to receive a procedure with or without tricuspid annuloplasty (TA). The primary 2-year end point was a composite of reoperation for tricuspid regurgitation, progression of tricuspid regurgitation by two grades from baseline or the presence of severe tricuspid regurgitation, or death. RESULTS: Patients who underwent mitral-valve surgery plus TA had fewer primary-end-point events than those who underwent mitral-valve surgery alone (3.9% vs. 10.2%) (relative risk, 0.37; 95% confidence interval [CI], 0.16 to 0.86; P = 0.02). Two-year mortality was 3.2% in the surgery-plus-TA group and 4.5% in the surgery-alone group (relative risk, 0.69; 95% CI, 0.25 to 1.88). The 2-year prevalence of progression of tricuspid regurgitation was lower in the surgery-plus-TA group than in the surgery-alone group (0.6% vs. 6.1%; relative risk, 0.09; 95% CI, 0.01 to 0.69). The frequencies of major adverse cardiac and cerebrovascular events, functional status, and quality of life were similar in the two groups at 2 years, although the incidence of permanent pacemaker implantation was higher in the surgery-plus-TA group than in the surgery-alone group (14.1% vs. 2.5%; rate ratio, 5.75; 95% CI, 2.27 to 14.60). CONCLUSIONS: Among patients undergoing mitral-valve surgery, those who also received TA had a lower incidence of a primary-end-point event than those who underwent mitral-valve surgery alone at 2 years, a reduction that was driven by less frequent progression to severe tricuspid regurgitation. Tricuspid repair resulted in more frequent permanent pacemaker implantation. Whether reduced progression of tricuspid regurgitation results in long-term clinical benefit can be determined only with longer follow-up. (Funded by the National Heart, Lung, and Blood Institute and the German Center for Cardiovascular Research; ClinicalTrials.gov number, NCT02675244.).
BACKGROUND: Tricuspid regurgitation is common in patients with severe degenerative mitral regurgitation. However, the evidence base is insufficient to inform a decision about whether to perform tricuspid-valve repair during mitral-valve surgery in patients who have moderate tricuspid regurgitation or less-than-moderate regurgitation with annular dilatation. METHODS: We randomly assigned 401 patients who were undergoing mitral-valve surgery for degenerative mitral regurgitation to receive a procedure with or without tricuspid annuloplasty (TA). The primary 2-year end point was a composite of reoperation for tricuspid regurgitation, progression of tricuspid regurgitation by two grades from baseline or the presence of severe tricuspid regurgitation, or death. RESULTS: Patients who underwent mitral-valve surgery plus TA had fewer primary-end-point events than those who underwent mitral-valve surgery alone (3.9% vs. 10.2%) (relative risk, 0.37; 95% confidence interval [CI], 0.16 to 0.86; P = 0.02). Two-year mortality was 3.2% in the surgery-plus-TA group and 4.5% in the surgery-alone group (relative risk, 0.69; 95% CI, 0.25 to 1.88). The 2-year prevalence of progression of tricuspid regurgitation was lower in the surgery-plus-TA group than in the surgery-alone group (0.6% vs. 6.1%; relative risk, 0.09; 95% CI, 0.01 to 0.69). The frequencies of major adverse cardiac and cerebrovascular events, functional status, and quality of life were similar in the two groups at 2 years, although the incidence of permanent pacemaker implantation was higher in the surgery-plus-TA group than in the surgery-alone group (14.1% vs. 2.5%; rate ratio, 5.75; 95% CI, 2.27 to 14.60). CONCLUSIONS: Among patients undergoing mitral-valve surgery, those who also received TA had a lower incidence of a primary-end-point event than those who underwent mitral-valve surgery alone at 2 years, a reduction that was driven by less frequent progression to severe tricuspid regurgitation. Tricuspid repair resulted in more frequent permanent pacemaker implantation. Whether reduced progression of tricuspid regurgitation results in long-term clinical benefit can be determined only with longer follow-up. (Funded by the National Heart, Lung, and Blood Institute and the German Center for Cardiovascular Research; ClinicalTrials.gov number, NCT02675244.).
Authors: Vinay Badhwar; J Scott Rankin; Max He; Jeffrey P Jacobs; Anthony P Furnary; Frank L Fazzalari; Sean O'Brien; James S Gammie; David M Shahian Journal: Ann Thorac Surg Date: 2016-08-25 Impact factor: 4.330
Authors: Yan Topilsky; Simon Maltais; Jose Medina Inojosa; Didem Oguz; Hector Michelena; Joseph Maalouf; Douglas W Mahoney; Maurice Enriquez-Sarano Journal: JACC Cardiovasc Imaging Date: 2018-08-15
Authors: Alec Vahanian; Friedhelm Beyersdorf; Fabien Praz; Milan Milojevic; Stephan Baldus; Johann Bauersachs; Davide Capodanno; Lenard Conradi; Michele De Bonis; Ruggero De Paulis; Victoria Delgado; Nick Freemantle; Martine Gilard; Kristina H Haugaa; Anders Jeppsson; Peter Jüni; Luc Pierard; Bernard D Prendergast; J Rafael Sádaba; Christophe Tribouilloy; Wojtek Wojakowski Journal: Eur J Cardiothorac Surg Date: 2021-10-22 Impact factor: 4.534
Authors: Antonio M Calafiore; Sabina Gallina; Angela L Iacò; Marco Contini; Antonio Bivona; Massimo Gagliardi; Paolo Bosco; Michele Di Mauro Journal: Ann Thorac Surg Date: 2009-03 Impact factor: 4.330
Authors: Andrew B Goldstone; Jessica L Howard; Jeffrey E Cohen; John W MacArthur; Pavan Atluri; James N Kirkpatrick; Y Joseph Woo Journal: J Thorac Cardiovasc Surg Date: 2014-08-06 Impact factor: 5.209
Authors: Piotr Mazur; Arman Arghami; Clark Zheng; Mohamad Alkhouli; Hartzell V Schaff; Joseph Dearani; Richard C Daly; Kevin Greason; Juan A Crestanello Journal: JTCVS Tech Date: 2022-05-14