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Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure.

Publication ,  Journal Article
Desai, RR; Vargas Abello, LM; Klein, AL; Marwick, TH; Krasuski, RA; Ye, Y; Nowicki, ER; Rajeswaran, J; Blackstone, EH; Pettersson, GB
Published in: J Thorac Cardiovasc Surg
November 2013

OBJECTIVES: To study the effect of mitral valve repair with or without concomitant tricuspid valve repair on functional tricuspid regurgitation and right ventricular function. METHODS: From 2001 to 2007, 1833 patients with degenerative mitral valve disease, a structurally normal tricuspid valve, and no coronary artery disease underwent mitral valve repair, and 67 underwent concomitant tricuspid valve repair. Right ventricular function (myocardial performance index and tricuspid annular plane systolic excursion) was measured before and after surgery using transthoracic echocardiography for randomly selected patients with tricuspid regurgitation grade 0, 1+, and 2+ (100 patients for each grade) and 93 with grade 3+/4+, 393 patients in total. RESULTS: In patients with mild (<3+) preoperative tricuspid regurgitation, mitral valve repair alone was associated with reduced tricuspid regurgitation and mild worsening of right ventricular function. Tricuspid regurgitation of 2+ or greater developed in fewer than 20%, and right ventricular function had improved, but not to preoperative levels, at 3 years. In patients with severe (3+/4+) preoperative tricuspid regurgitation, mitral valve repair alone reduced tricuspid regurgitation and improved right ventricular function; however, tricuspid regurgitation of 2+ or greater returned and right ventricular function worsened toward preoperative levels within 3 years. Concomitant tricuspid valve repair effectively eliminated severe tricuspid regurgitation and improved right ventricular function. Also, over time, tricuspid regurgitation did not return and right ventricular function continued to improve to levels comparable to that of patients with lower grades of preoperative tricuspid regurgitation. CONCLUSIONS: In patients with mitral valve disease and severe tricuspid regurgitation, mitral valve repair alone was associated with improved tricuspid regurgitation and right ventricular function. However, the improvements were incomplete and temporary. In contrast, concomitant tricuspid valve repair effectively and durably eliminated severe tricuspid regurgitation and improved right ventricular function toward normal, supporting an aggressive approach to important functional tricuspid regurgitation.

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Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

November 2013

Volume

146

Issue

5

Start / End Page

1126 / 1132.e10

Location

United States

Related Subject Headings

  • Ventricular Function, Right
  • Ventricular Dysfunction, Right
  • Tricuspid Valve Insufficiency
  • Treatment Outcome
  • Time Factors
  • Severity of Illness Index
  • Respiratory System
  • Recovery of Function
  • Multivariate Analysis
  • Monte Carlo Method
 

Citation

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Desai, R. R., Vargas Abello, L. M., Klein, A. L., Marwick, T. H., Krasuski, R. A., Ye, Y., … Pettersson, G. B. (2013). Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. J Thorac Cardiovasc Surg, 146(5), 1126-1132.e10. https://doi.org/10.1016/j.jtcvs.2012.08.061
Desai, Ravi R., Lina Maria Vargas Abello, Allan L. Klein, Thomas H. Marwick, Richard A. Krasuski, Ying Ye, Edward R. Nowicki, Jeevanantham Rajeswaran, Eugene H. Blackstone, and Gösta B. Pettersson. “Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure.J Thorac Cardiovasc Surg 146, no. 5 (November 2013): 1126-1132.e10. https://doi.org/10.1016/j.jtcvs.2012.08.061.
Desai RR, Vargas Abello LM, Klein AL, Marwick TH, Krasuski RA, Ye Y, et al. Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. J Thorac Cardiovasc Surg. 2013 Nov;146(5):1126-1132.e10.
Desai, Ravi R., et al. “Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure.J Thorac Cardiovasc Surg, vol. 146, no. 5, Nov. 2013, pp. 1126-1132.e10. Pubmed, doi:10.1016/j.jtcvs.2012.08.061.
Desai RR, Vargas Abello LM, Klein AL, Marwick TH, Krasuski RA, Ye Y, Nowicki ER, Rajeswaran J, Blackstone EH, Pettersson GB. Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. J Thorac Cardiovasc Surg. 2013 Nov;146(5):1126-1132.e10.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

November 2013

Volume

146

Issue

5

Start / End Page

1126 / 1132.e10

Location

United States

Related Subject Headings

  • Ventricular Function, Right
  • Ventricular Dysfunction, Right
  • Tricuspid Valve Insufficiency
  • Treatment Outcome
  • Time Factors
  • Severity of Illness Index
  • Respiratory System
  • Recovery of Function
  • Multivariate Analysis
  • Monte Carlo Method