Mitral Valve Repair Without Repair of Moderate Tricuspid Regurgitation

Michele De Bonis, Elisabetta Lapenna, Alberto Pozzoli, Teodora Nisi, Andrea Giacomini, Mariachiara Calabrese, Giovanni La Canna, Federico Pappalardo, Antonio Miceli, Mattia Glauber, Fabio Barili, Ottavio Alfieri

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The objective of this study was to assess the fate at long term of mild-to-moderate functional tricuspid regurgitation (TR) left untreated at the time ofmitral valve repair in patients with dilated cardiomyopathy. Methods: We selected from our prospective hospital database 84 patients (age, 64 ± 9.6 years; ejection fraction, 0.31 ± 0.064) who underwent mitral repair for secondary mitral regurgitation in whom concomitant mild-to-moderate TR (nonlinear scale 1 to 4+) was left untreated. Tricuspid regurgitation was classified as mild in 61 patients (72.6%) and moderate in 23 patients (27.3%). Annular dilatation itself was not systematically measured and was not used as a trigger for tricuspid annuloplasty. Most of the patients were in New York Heart Association functional class III or IV (56 of 84; 66.7%). Results: At a median follow-up of 7.3 years (interquartile range, 4.5 to 9.3), 17 patients (20.2%) had moderate-to-severe TR and 21 patients (25%) showed a progression of at least two grades of their untreated preoperative TR. Freedom from moderate-to-severe TR or from progression of at least two grades of the baseline TRwas 77% ± 5% at 5 years and 56.7% ± 8.4% at 10 years. Multivariate analysis identified preoperative right ventricular dysfunction (hazard ratio, 7.2; 95% confidence interval, 2.8 to 23; p= 0.001) and age (hazard ratio, 1; 95% confidence interval, 1.0 1.1; p= 0.03) as independent predictors of TR worsening. Conclusions: A significant number of dilated cardiomyopathy patients with mild-to-moderate TR left untreated at the time of mitral repair show important TR atfollow-up. In this setting, a more aggressive policy should be used taking into consideration the degree of annular dilatation and the function of the right ventricle and not simply the grade of TR.

Original languageEnglish
JournalAnnals of Thoracic Surgery
DOIs
Publication statusAccepted/In press - 2015

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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