Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty.
BACKGROUND
The durability of tricuspid valve (TV) repair by annuloplasty is limited. Identification of mechanisms of recurrent or residual tricuspid regurgitation (TR) after annuloplasty is necessary to improve results of TV repair. The purpose of this study was to investigate echocardiographic determinants of mid-term outcome after TV annuloplasty.


RESULTS
This study consisted of 39 patients with functional TR who had echocardiography preoperatively, early postoperatively (5+/-2 days), and >1 year (20+/-6 months) after TV annuloplasty. Detailed echocardiographic measurements were performed, including TR severity, TV annular dimension, TV leaflet displacement, left ventricular (LV) function, and right ventricular (RV) function and pressures. Preoperative leaflet tethering height and area predicted early and mid-term outcome of annuloplasty. Early postoperative LV ejection fraction and TR severity influenced degree of TR >1 year after surgery. In addition, increased RV pressure was related to worse TR during late follow-up.


CONCLUSIONS
Although TV tethering is an important determinant of recurrent or residual TR, LV and RV function and pressures impact repair durability. These factors identify patients at risk for repair failure; such individuals require development of additional surgical strategies to improve results of tricuspid valve repair and close surveillance after surgery.
Fukuda
Shota
S
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F15, Cleveland, Ohio 44195, USA.
Gillinov
A Marc
AM
McCarthy
Patrick M
PM
Stewart
William J
WJ
Song
Jong-Min
JM
Kihara
Takashi
T
Daimon
Masao
M
Shin
Mi-Seong
MS
Thomas
James D
JD
Shiota
Takahiro
T
D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D016208:Databases, Factual; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D009038:Motion; D015588:Observer Variation; D019736:Prostheses and Implants; D012008:Recurrence; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume; D013536:Suture Techniques; D013599:Systole; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*