Mitral Valve Repair Without Repair of Moderate Tricuspid Regurgitation

被引:17
作者
De Bonis, Michele [1 ]
Lapenna, Elisabetta
Pozzoli, Alberto
Nisi, Teodora
Giacomini, Andrea
Calabrese, Mariachiara
La Canna, Giovanni
Pappalardo, Federico
Miceli, Antonio
Glauber, Mattia
Barili, Fabio
Alfieri, Ottavio
机构
[1] IRCCS San Raffaele Sci Inst, Dept Cardiac Surg, I-20132 Milan, Italy
关键词
PROGRESSION; DISEASE; ANNULOPLASTY; DILATATION; SECONDARY; SURGERY; ANNULUS;
D O I
10.1016/j.athoracsur.2015.05.108
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 of mitral 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 (inter-quartile 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 TR was 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 at follow-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. (C) 2015 by The Society of Thoracic Surgeons
引用
收藏
页码:2206 / 2212
页数:7
相关论文
共 18 条
[1]   Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery [J].
Benedetto, Umberto ;
Melina, Giovanni ;
Angeloni, Emiliano ;
Refice, Simone ;
Roscitano, Antonino ;
Comito, Cosimo ;
Sinatra, Riccardo .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2012, 143 (03) :632-638
[2]  
BRAUNWALD NS, 1967, CIRCULATION, V35, pI63
[3]   Mitral Valve Surgery for Functional Mitral Regurgitation: Should Moderate-or-More Tricuspid Regurgitation Be Treated? A Propensity Score Analysis [J].
Calafiore, Antonio M. ;
Gallina, Sabina ;
Iaco, Angela L. ;
Contini, Marco ;
Bivona, Antonio ;
Gagliardi, Massimo ;
Bosco, Paolo ;
Di Mauro, Michele .
ANNALS OF THORACIC SURGERY, 2009, 87 (03) :698-703
[4]   Clinical and Echocardiographic Impact of Functional Tricuspid Regurgitation Repair at the Time of Mitral Valve Replacement [J].
Chan, Vincent ;
Burwash, Ian G. ;
Lam, B-Khanh ;
Auyeung, Titus ;
Tran, Anthony ;
Mesana, Thierry G. ;
Ruel, Marc .
ANNALS OF THORACIC SURGERY, 2009, 88 (04) :1209-1215
[5]   Tricuspid regurgitation secondary to mitral valve disease: Tricuspid annulus function as guide to tricuspid valve repair [J].
Colombo, T ;
Russo, C ;
Ciliberto, GR ;
Lanfranconi, M ;
Bruschi, G ;
Agati, S ;
Vitali, E .
CARDIOVASCULAR SURGERY, 2001, 9 (04) :369-377
[6]   Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy [J].
De Bonis, Michele ;
Lapenna, Elisabetta ;
Sorrentino, Flavia ;
La Canna, Giovanni ;
Grimaldi, Antonio ;
Maisano, Francesco ;
Torracca, Lucia ;
Alfieri, Ottavio .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2008, 33 (04) :600-605
[7]   Secondary tricuspid regurgitation or dilatation: Which should be the criteria for surgical repair? [J].
Dreyfus, GD ;
Corbi, PJ ;
Chan, J ;
Bahrami, T .
ANNALS OF THORACIC SURGERY, 2005, 79 (01) :127-132
[8]  
DURAN CMG, 1980, J THORAC CARDIOV SUR, V80, P849
[9]   Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty [J].
Fukuda, Shota ;
Gillinov, A. Marc ;
McCarthy, Patrick M. ;
Stewart, William J. ;
Song, Jong-Min ;
Kihara, Takashi ;
Daimon, Masao ;
Shin, Mi-Seong ;
Thomas, James D. ;
Shiota, Takahiro .
CIRCULATION, 2006, 114 :I582-I587
[10]  
Izumi C, 2002, J HEART VALVE DIS, V11, P353