title: Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure.
abstract: OBJECTIVE
  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.
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Desai
authors.forename: Lina Maria
authors.initials: LM
authors.lastname: Vargas Abello
authors.forename: Allan L
authors.initials: AL
authors.lastname: Klein
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
authors.forename: Richard A
authors.initials: RA
authors.lastname: Krasuski
authors.forename: Ying
authors.initials: Y
authors.lastname: Ye
authors.forename: Edward R
authors.initials: ER
authors.lastname: Nowicki
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Gösta B
authors.initials: GB
authors.lastname: Pettersson
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008390:Markov Chains; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D016278:Ventricular Function, Right