Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty.
right ventricular remodeling
tricuspid annuloplasty
tricuspid regurgitation
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
18
04
2020
revised:
30
05
2020
accepted:
04
06
2020
pubmed:
12
7
2020
medline:
11
8
2020
entrez:
12
7
2020
Statut:
ppublish
Résumé
The aim of the present retrospective study was to evaluate the influence of preoperative right ventricular (RV) and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and right ventricle. From May 2009 to December 2015, 423 patients who had undergone TA for functional tricuspid regurgitation (TR) were included in the study. Residual and recurrent TR were defined as moderate or more TR at discharge and follow-up, respectively. RV remodeling was defined as RV dysfunction and/or dilation. Residual TR after TA was recorded in 54 patients (13%). Five-year freedom from TR recurrence was 81% ± 3% in patients without residual TR and 41 ± 8 in patients with residual TR (P < .001). In patients without residual TR, the following risk factors for recurrent TR and late RV remodeling were identified: preoperative systolic pulmonary artery pressure, preoperative RV remodeling, severe preoperative TR or less than severe TR but with TV apparatus remodeling, and etiology of mitral regurgitation. Cox analysis with time-dependent variables confirmed TR recurrence (hazard ratio [HR]: 3.1) and late RV remodeling (HR: 6.5) as risk factors for lower survival. No protective effect of either flexible band or rigid ring TA compared with DeVega procedure was found. Similarly, preoperative atrial fibrillation and pacemaker dependency, late failure of mitral valve surgery did not affect the fate of TR. Prophylactic TA should be encouraged among surgeons. TA at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of the present retrospective study was to evaluate the influence of preoperative right ventricular (RV) and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and right ventricle.
METHODS
METHODS
From May 2009 to December 2015, 423 patients who had undergone TA for functional tricuspid regurgitation (TR) were included in the study. Residual and recurrent TR were defined as moderate or more TR at discharge and follow-up, respectively. RV remodeling was defined as RV dysfunction and/or dilation.
RESULTS
RESULTS
Residual TR after TA was recorded in 54 patients (13%). Five-year freedom from TR recurrence was 81% ± 3% in patients without residual TR and 41 ± 8 in patients with residual TR (P < .001). In patients without residual TR, the following risk factors for recurrent TR and late RV remodeling were identified: preoperative systolic pulmonary artery pressure, preoperative RV remodeling, severe preoperative TR or less than severe TR but with TV apparatus remodeling, and etiology of mitral regurgitation. Cox analysis with time-dependent variables confirmed TR recurrence (hazard ratio [HR]: 3.1) and late RV remodeling (HR: 6.5) as risk factors for lower survival. No protective effect of either flexible band or rigid ring TA compared with DeVega procedure was found. Similarly, preoperative atrial fibrillation and pacemaker dependency, late failure of mitral valve surgery did not affect the fate of TR.
CONCLUSIONS
CONCLUSIONS
Prophylactic TA should be encouraged among surgeons. TA at the time of left-sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1891-1900Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Nemoto N, Lesser JR, Pedersen WR, et al. Pathogenic structural heart changes in early tricuspid regurgitation. J Thorac Cardiovasc Surg. 2015;150:323-330.
Dreyfus GD, Corbi PJ, Chan KM, Bahrami T. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg. 2005;79:127-132.
Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739-2791.
Antunes MJ, Rodríguez-Palomares J, Prendergast B, et al. Management of tricuspid valve regurgitation: position statement of the European Society of Cardiology Working Groups of Cardiovascular Surgery and Valvular Heart Disease. Eur J Cardiothorac Surg. 2017;52:1022-1030.
Ro SK, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery. J Thorac Cardiovasc Surg. 2013;146:1092-1097.
Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation. 2009;119:2718-2725.
Calafiore AM, Foschi M, Kheirallah H, et al. Early failure of tricuspid annuloplasty. Should we repair the tricuspid valve at an earlier stage? The role of right ventricle and tricuspid apparatus. J Card Surg. 2019;34:404-411.
Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685-713.
Di Mauro M, Foschi M, Tancredi F, et al. Additive and independent prognostic role of abnormal right ventricle and pulmonary hypertension in mitral-tricuspid surgery. Int J Cardiol. 2018;252:39-43.
Nishimura RA, Otto CM, Bonow RO, et al. AHA/ACC Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;2014(129):e521-e643.
Calafiore AM, Iacò AL, Romeo A, et al. Echocardiographic-based treatment of functional tricuspid regurgitation. J Thorac Cardiovasc Surg. 2011;142:308-313.
McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg. 2004;127:674-685.
Kuwaki K, Morishita K, Tsukamoto M, Abe T. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg. 2001;20:577-582.
Min SY, Song JM, Kim JH, et al. Geometric changes after tricuspid annuloplasty and predictors of residual tricuspid regurgitation: a real-time three-dimensional echocardiography study. Eur Heart J. 2010;31:2871-2880.
Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg. 2010;139:1473-1482. e5.
Ghanta RK, Chen R, Narayanasamy N, et al. Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation: midterm results of 237 consecutive patients. J Thorac Cardiovasc Surg. 2007;133:117-126.
Fukuda S, Gillinov AM, McCarthy PM, et al. Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation. 2006;114(1 suppl):I582-I587.
Desai RR, Vargas Abello LM, Klein AL, et al. Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. J Thorac Cardiovasc Surg. 2013;146:1126-1132.
Kara I, Koksal C, Erkin A, et al. Outcomes of mild to moderate functional tricuspid regurgitation in patients undergoing mitral valve operations: a meta-analysis of 2488 patients. Ann Thorac Surg. 2015;100:2398-2407.
Badhwar V, Rankin JS, He M, et al. Performing concomitant tricuspid valve repair at the time of mitral valve operations is not associated with increased operative mortality. Ann Thorac Surg. 2017;103:587-593.
Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol. 2009;53:401-408.
Bertrand PB, Koppers G, Verbrugge FH, et al. Tricuspid annuloplasty concomitant with mitral valve surgery: effects on right ventricular remodeling. J Thorac Cardiovasc Surg. 2014;147:1256-1264.
Van de Veire NR, Braun J, Delgado V, et al. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg. 2011;141:1431-1439.
Pettinari M, De Kerchove L, Lazam S, et al. Mid-term results of a randomized trial of tricuspid annuloplasty for less-than-severe functional tricuspid regurgitation at the time of mitral valve surgery. Eur J Cardiothorac Surg. 2019;55:851-858.
Yiu KH, Wong A, Pu L, et al. Prognostic value of preoperative right ventricular geometry and tricuspid valve tethering area in patients undergoing tricuspid annuloplasty. Circulation. 2014;129:87-92.
Dietz MF, Prihadi EA, van der Bijl P, et al. Prognostic implications of right ventricular remodeling and function in patients with significant secondary tricuspid regurgitation. Circulation. 2019;140:836-845.
Chikwe J, Itagaki S, Anyanwu A, Adams DH. Impact of concomitant tricuspid annuloplasty on tricuspid regurgitation, right ventricular function, and pulmonary artery hypertension after repair of mitral valve prolapse. J Am Coll Cardiol. 2015;65:1931-1938.
Chen Y, Liu JH, Chan D, et al. Prevalence, predictors, and clinical outcome of residual pulmonary hypertension following tricuspid annuloplasty. J Am Heart Assoc. 2016;5:e003353.
De Bonis M, Lapenna E, Sorrentino F, et al. Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy. Eur J Cardiothorac Surg. 2008;33:600-606.
Fukunaga N, Okada Y, Konishi Y, Murashita T, Koyama T. Late outcome of tricuspid annuloplasty using a flexible band/ring for functional tricuspid regurgitation. Circ J. 2015;79:1299-1306.
Ito H, Mizumoto T, Sawada Y, Fujinaga K, Tempaku H, Shimpo H. Determinants of recurrent tricuspid regurgitation following tricuspid valve annuloplasty during mitral valve surgery. J Card Surg. 2017;32:237-244.
Shinn SH, Dayan V, Schaff HV, et al. Outcomes of ring versus suture annuloplasty for tricuspid valve repair in patients undergoing mitral valve surgery. J Thorac Cardiovasc Surg. 2016;152:406-415. e3.
Hata H, Fujita T, Miura S, et al. Long-term outcomes of suture versus ring tricuspid annuloplasty for functional tricuspid regurgitation. Circ J. 2017;81:1432-1438.
Calafiore AM, Iacò AL, Contini M, Di Mauro M. A single size band, 50mmlong, for tricuspid annuloplasty. Eur J Cardiothorsc Surg. 2008;34:677-679.
Calafiore AM, Di Mauro M. Tricuspid valve repair-indications and techniques: suture annuloplasty and band annuloplasty. Op Tech Thor Cardiovasc Surg. 2011;16:86-96.
Frater R. Tricuspid insufficiency. J Thorac Cardiovasc Surg. 2003;125:9-11.
Guenther T, Mazzitelli D, Noebauer C, et al. Tricuspid valve repair: is ring annuloplasty superior? Eur J Cardiothorac Surg. 2013;43:58-65.
Khorsandi M, Banerjee A, Singh H, Srivastava AR. Is a tricuspid annuloplasty ring significantly better than a De Vega's annuloplasty stitch when repairing severe tricuspid regurgitation? Interact Cardiovasc Thorac Surg. 2012;15:129-135.
Murashita T, Okada Y, Kanemitsu H, et al. Long-term outcomes of tricuspid annuloplasty for functional tricuspid regurgitation associated with degenerative mitral regurgitation: suture annuloplasty versus ring annuloplasty using a flexible band. Ann Thorac Cardiovasc Surg. 2014;20:1026-1033.
Gatti G, Dell'Angela L, Morosin M, et al. Tricuspid annuloplasty for tricuspid regurgitation secondary to left-sided heart valve disease: immediate outcomes and risk factors for late failure. Can J Cardiol. 2016 Jun;32(6):760-766.
Huang X, Gu C, Men X, et al. Repair of functional tricuspid regurgitation: comparison between suture annuloplasty and rings annuloplasty. Ann Thorac Surg. 2014;97:1286-1292.
Pfannmuller B, Doenst T, Eberhardt K, Seeburger J, Borger MA, Mohr FW. Increased risk of dehiscence after tricuspid valve repair with rigid annuloplasty rings. J Thorac Cardiovasc Surg. 2012;143:1050-1055.
Izutani H, Nakamura T, Kawachi K. Flexible band versus rigid ring annuloplasty for functional tricuspid regurgitation. Heart Int. 2010;5:e13.
Wang N, Phan S, Tian DH, Yan TD, Phan K. Flexible band versus rigid ring annuloplasty for tricuspid regurgitation: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2017;6:194-203.
De Bonis M, Lapenna E, Di Sanzo S, et al. Long-term results (up to 14 years) of the clover technique for the treatment of complex tricuspid valve regurgitation. Eur J Cardiothorac Surg. 2017;52:125-130.
Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg. 2008;34:908-910.
Calafiore AM, De Filippo C, Totaro A, Pelini P, Di Mauro M. Full orifice patching without annuloplasty for severe functional tricuspid valve regurgitation. Thorac Cardiovasc Surg. 2018;66:572-574.