title: Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement.
abstract: BACKGROUND
  The indications for tricuspid valve repair in the setting of mitral valve disease and concomitant tricuspid regurgitation (TR) remain unclear. We examined patients undergoing mitral valve replacement (MVR) to determine the effect of TR and tricuspid valve repair on survival, functional status, and postoperative TR.
  
  
  METHODS
  Between 1990 and 2005, 624 patients underwent MVR. Data included detailed serial echocardiographic tricuspid valve measurements, functional status, and survival data. Preoperative TR exceeded 2+ in 231: 125 received tricuspid repair and MVR, whereas 106 received MVR alone. Clinical and echocardiographic follow-up were complete (average, 6.8 +/- 4.8 years). Parametric and semi-parametric tests were used to analyze outcomes.
  
  
  RESULTS
  TR exceeding 2+ at operation was associated with a 53% increase in late death (p = 0.003). Tricuspid repair prevented echocardiographic progression of TR and improved congestive heart failure symptoms (both p < 0.01). Overall survival did not improve (p = 0.3). A trend to worsening TR in patients was noted with a larger tricuspid annulus diameter and without significant (<or= 1+) TR preoperatively (odds ratio, 1.4 per cm increase in annulus diameter; p = 0.5), but this was not associated with worse functional or vital outcomes.
  
  
  CONCLUSIONS
  In patients undergoing MVR, tricuspid repair is indicated when TR exceeds 2+ to alleviate heart failure symptoms, but without significantly improving survival in this population. TR of 2+ or less may not require repair. Echocardiographic tricuspid annular dimensions alone, in the absence of significant (<or= 1+) TR preoperatively, should not dictate the performance of tricuspid repair.
authors.affiliation: Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Chan
authors.forename: Ian G
authors.initials: IG
authors.lastname: Burwash
authors.forename: B-Khanh
authors.initials: BK
authors.lastname: Lam
authors.forename: Titus
authors.initials: T
authors.lastname: Auyeung
authors.forename: Anthony
authors.initials: A
authors.lastname: Tran
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Mesana
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016343:Monitoring, Intraoperative; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000503:physiopathology* / Q000601:surgery