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Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation.

Publication ,  Journal Article
Bertrand, PB; Overbey, JR; Zeng, X; Levine, RA; Ailawadi, G; Acker, MA; Smith, PK; Thourani, VH; Bagiella, E; Miller, MA; Gupta, L; Mack, MJ ...
Published in: J Am Coll Cardiol
February 16, 2021

BACKGROUND: Whether to repair nonsevere tricuspid regurgitation (TR) during surgery for ischemic mitral valve regurgitation (IMR) remains uncertain. OBJECTIVES: The goal of this study was to investigate the incidence, predictors, and clinical significance of TR progression and presence of ≥moderate TR after IMR surgery. METHODS: Patients (n = 492) with untreated nonsevere TR within 2 prospectively randomized IMR trials were included. Key outcomes were TR progression (either progression by ≥2 grades, surgery for TR, or severe TR at 2 years) and presence of ≥moderate TR at 2 years. RESULTS: Patients' mean age was 66 ± 10 years (67% male), and TR distribution was 60% ≤trace, 31% mild, and 9% moderate. Among 2-year survivors, TR progression occurred in 20 (6%) of 325 patients. Baseline tricuspid annular diameter (TAD) was not predictive of TR progression. At 2 years, 37 (11%) of 323 patients had ≥moderate TR. Baseline TR grade, indexed TAD, and surgical ablation for atrial fibrillation were independent predictors of ≥moderate TR. However, TAD alone had poor discrimination (area under the curve, ≤0.65). Presence of ≥moderate TR at 2 years was higher in patients with MR recurrence (20% vs. 9%; p = 0.02) and a permanent pacemaker/defibrillator (19% vs. 9%; p = 0.01). Clinical event rates (composite of ≥1 New York Heart Association functional class increase, heart failure hospitalization, mitral valve surgery, and stroke) were higher in patients with TR progression (55% vs. 23%; p = 0.003) and ≥moderate TR at 2 years (38% vs. 22%; p = 0.04). CONCLUSIONS: After IMR surgery, progression of unrepaired nonsevere TR is uncommon. Baseline TAD is not predictive of TR progression and is poorly discriminative of ≥moderate TR at 2 years. TR progression and presence of ≥moderate TR are associated with clinical events. (Comparing the Effectiveness of a Mitral Valve Repair Procedure in Combination With Coronary Artery Bypass Grafting [CABG] Versus CABG Alone in People With Moderate Ischemic Mitral Regurgitation, NCT00806988; Comparing the Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in People With Severe Chronic Ischemic Mitral Regurgitation, NCT00807040).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

February 16, 2021

Volume

77

Issue

6

Start / End Page

713 / 724

Location

United States

Related Subject Headings

  • Tricuspid Valve Insufficiency
  • Tricuspid Valve
  • Stroke
  • Severity of Illness Index
  • Recurrence
  • Prospective Studies
  • Pacemaker, Artificial
  • Myocardial Ischemia
  • Mitral Valve Insufficiency
  • Male
 

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Bertrand, P. B., Overbey, J. R., Zeng, X., Levine, R. A., Ailawadi, G., Acker, M. A., … Cardiothoracic Surgical Trials Network (CTSN), . (2021). Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation. J Am Coll Cardiol, 77(6), 713–724. https://doi.org/10.1016/j.jacc.2020.11.066
Bertrand, Philippe B., Jessica R. Overbey, Xin Zeng, Robert A. Levine, Gorav Ailawadi, Michael A. Acker, Peter K. Smith, et al. “Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation.J Am Coll Cardiol 77, no. 6 (February 16, 2021): 713–24. https://doi.org/10.1016/j.jacc.2020.11.066.
Bertrand PB, Overbey JR, Zeng X, Levine RA, Ailawadi G, Acker MA, et al. Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation. J Am Coll Cardiol. 2021 Feb 16;77(6):713–24.
Bertrand, Philippe B., et al. “Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation.J Am Coll Cardiol, vol. 77, no. 6, Feb. 2021, pp. 713–24. Pubmed, doi:10.1016/j.jacc.2020.11.066.
Bertrand PB, Overbey JR, Zeng X, Levine RA, Ailawadi G, Acker MA, Smith PK, Thourani VH, Bagiella E, Miller MA, Gupta L, Mack MJ, Gillinov AM, Giustino G, Moskowitz AJ, Gelijns AC, Bowdish ME, O’Gara PT, Gammie JS, Hung J, Cardiothoracic Surgical Trials Network (CTSN). Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation. J Am Coll Cardiol. 2021 Feb 16;77(6):713–724.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

February 16, 2021

Volume

77

Issue

6

Start / End Page

713 / 724

Location

United States

Related Subject Headings

  • Tricuspid Valve Insufficiency
  • Tricuspid Valve
  • Stroke
  • Severity of Illness Index
  • Recurrence
  • Prospective Studies
  • Pacemaker, Artificial
  • Myocardial Ischemia
  • Mitral Valve Insufficiency
  • Male