Prognostic Impact and Late Evolution of Untreated Moderate (2/4+) Functional Tricuspid Regurgitation in Patients Undergoing Aortic Valve Replacement

Maurizio Taramasso, Francesco Maisano, Michele De Bonis, Alberto Pozzoli, Davide Schiavi, Stefano Benussi, Antonio Grimaldi, Giovanni La Canna, Ottavio Alfieri

Research output: Contribution to journalArticle

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Abstract

Objectives The aim of the present study was to evaluate the prognostic impact and late evolution of associated tricuspid regurgitation (TR) 2/4+ after aortic valve replacement (AVR). Methods We evaluated 61 patients who underwent AVR between 2003 and 2012 (35 for aortic stenosis [AS], 26 for aortic regurgitation [AR]) with associated untreated TR 2/4+. Patients with concomitant mitral disease were excluded. Median follow-up was 3.2 years. Serial echocardiographic and clinical data were collected and analyzed. Results Mean age was 65 ± 13 years; 26% of the patients were in NYHA class III-IV. Left ventricular ejection fraction was 53 ± 11%. Comorbidity included: chronic obstructive pulmonary disease in 5%, chronic renal failure in 13%, coronary artery disease in 20%, history of stroke/TIA in 8%. Thirty-day mortality was 1.6%. Overall actuarial survival was 83 ± 6% at 6.5 years, with a freedom from cardiac death of 90 ± 5%. Freedom from TR ≥3+ was 86 ± 6% at 6.5 years. At last follow-up, 82% of the patients had TR 0-1/4+, 9% had TR 2/4+, 4.5% had TR 3/4+ and 4.5% had TR 4/4+. Occurrence of TR ≥ 3+ at follow-up was associated with increased cardiac mortality (HR 10.5; p = 0.009). Conclusions preoperative untreated TR 2/4+ improves or remains stable in the majority of patients. The poor outcomes associated with TR > 2+ suggest the need for better methods to identify subjects at risk for TR progression. doi: 10.1111/jocs.12656 (J Card Surg 2016;31:9-14)

Original languageEnglish
Pages (from-to)9-14
Number of pages6
JournalJournal of Cardiac Surgery
Volume31
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

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Tricuspid Valve Insufficiency
Aortic Valve
Aortic Valve Insufficiency
Mortality
Aortic Valve Stenosis
Stroke Volume
Chronic Obstructive Pulmonary Disease
Chronic Kidney Failure
Comorbidity
Coronary Artery Disease
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Prognostic Impact and Late Evolution of Untreated Moderate (2/4+) Functional Tricuspid Regurgitation in Patients Undergoing Aortic Valve Replacement. / Taramasso, Maurizio; Maisano, Francesco; De Bonis, Michele; Pozzoli, Alberto; Schiavi, Davide; Benussi, Stefano; Grimaldi, Antonio; La Canna, Giovanni; Alfieri, Ottavio.

In: Journal of Cardiac Surgery, Vol. 31, No. 1, 01.01.2016, p. 9-14.

Research output: Contribution to journalArticle

Taramasso, Maurizio ; Maisano, Francesco ; De Bonis, Michele ; Pozzoli, Alberto ; Schiavi, Davide ; Benussi, Stefano ; Grimaldi, Antonio ; La Canna, Giovanni ; Alfieri, Ottavio. / Prognostic Impact and Late Evolution of Untreated Moderate (2/4+) Functional Tricuspid Regurgitation in Patients Undergoing Aortic Valve Replacement. In: Journal of Cardiac Surgery. 2016 ; Vol. 31, No. 1. pp. 9-14.
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abstract = "Objectives The aim of the present study was to evaluate the prognostic impact and late evolution of associated tricuspid regurgitation (TR) 2/4+ after aortic valve replacement (AVR). Methods We evaluated 61 patients who underwent AVR between 2003 and 2012 (35 for aortic stenosis [AS], 26 for aortic regurgitation [AR]) with associated untreated TR 2/4+. Patients with concomitant mitral disease were excluded. Median follow-up was 3.2 years. Serial echocardiographic and clinical data were collected and analyzed. Results Mean age was 65 ± 13 years; 26{\%} of the patients were in NYHA class III-IV. Left ventricular ejection fraction was 53 ± 11{\%}. Comorbidity included: chronic obstructive pulmonary disease in 5{\%}, chronic renal failure in 13{\%}, coronary artery disease in 20{\%}, history of stroke/TIA in 8{\%}. Thirty-day mortality was 1.6{\%}. Overall actuarial survival was 83 ± 6{\%} at 6.5 years, with a freedom from cardiac death of 90 ± 5{\%}. Freedom from TR ≥3+ was 86 ± 6{\%} at 6.5 years. At last follow-up, 82{\%} of the patients had TR 0-1/4+, 9{\%} had TR 2/4+, 4.5{\%} had TR 3/4+ and 4.5{\%} had TR 4/4+. Occurrence of TR ≥ 3+ at follow-up was associated with increased cardiac mortality (HR 10.5; p = 0.009). Conclusions preoperative untreated TR 2/4+ improves or remains stable in the majority of patients. The poor outcomes associated with TR > 2+ suggest the need for better methods to identify subjects at risk for TR progression. doi: 10.1111/jocs.12656 (J Card Surg 2016;31:9-14)",
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AU - Taramasso, Maurizio

AU - Maisano, Francesco

AU - De Bonis, Michele

AU - Pozzoli, Alberto

AU - Schiavi, Davide

AU - Benussi, Stefano

AU - Grimaldi, Antonio

AU - La Canna, Giovanni

AU - Alfieri, Ottavio

PY - 2016/1/1

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N2 - Objectives The aim of the present study was to evaluate the prognostic impact and late evolution of associated tricuspid regurgitation (TR) 2/4+ after aortic valve replacement (AVR). Methods We evaluated 61 patients who underwent AVR between 2003 and 2012 (35 for aortic stenosis [AS], 26 for aortic regurgitation [AR]) with associated untreated TR 2/4+. Patients with concomitant mitral disease were excluded. Median follow-up was 3.2 years. Serial echocardiographic and clinical data were collected and analyzed. Results Mean age was 65 ± 13 years; 26% of the patients were in NYHA class III-IV. Left ventricular ejection fraction was 53 ± 11%. Comorbidity included: chronic obstructive pulmonary disease in 5%, chronic renal failure in 13%, coronary artery disease in 20%, history of stroke/TIA in 8%. Thirty-day mortality was 1.6%. Overall actuarial survival was 83 ± 6% at 6.5 years, with a freedom from cardiac death of 90 ± 5%. Freedom from TR ≥3+ was 86 ± 6% at 6.5 years. At last follow-up, 82% of the patients had TR 0-1/4+, 9% had TR 2/4+, 4.5% had TR 3/4+ and 4.5% had TR 4/4+. Occurrence of TR ≥ 3+ at follow-up was associated with increased cardiac mortality (HR 10.5; p = 0.009). Conclusions preoperative untreated TR 2/4+ improves or remains stable in the majority of patients. The poor outcomes associated with TR > 2+ suggest the need for better methods to identify subjects at risk for TR progression. doi: 10.1111/jocs.12656 (J Card Surg 2016;31:9-14)

AB - Objectives The aim of the present study was to evaluate the prognostic impact and late evolution of associated tricuspid regurgitation (TR) 2/4+ after aortic valve replacement (AVR). Methods We evaluated 61 patients who underwent AVR between 2003 and 2012 (35 for aortic stenosis [AS], 26 for aortic regurgitation [AR]) with associated untreated TR 2/4+. Patients with concomitant mitral disease were excluded. Median follow-up was 3.2 years. Serial echocardiographic and clinical data were collected and analyzed. Results Mean age was 65 ± 13 years; 26% of the patients were in NYHA class III-IV. Left ventricular ejection fraction was 53 ± 11%. Comorbidity included: chronic obstructive pulmonary disease in 5%, chronic renal failure in 13%, coronary artery disease in 20%, history of stroke/TIA in 8%. Thirty-day mortality was 1.6%. Overall actuarial survival was 83 ± 6% at 6.5 years, with a freedom from cardiac death of 90 ± 5%. Freedom from TR ≥3+ was 86 ± 6% at 6.5 years. At last follow-up, 82% of the patients had TR 0-1/4+, 9% had TR 2/4+, 4.5% had TR 3/4+ and 4.5% had TR 4/4+. Occurrence of TR ≥ 3+ at follow-up was associated with increased cardiac mortality (HR 10.5; p = 0.009). Conclusions preoperative untreated TR 2/4+ improves or remains stable in the majority of patients. The poor outcomes associated with TR > 2+ suggest the need for better methods to identify subjects at risk for TR progression. doi: 10.1111/jocs.12656 (J Card Surg 2016;31:9-14)

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