title: Right ventricular reduction for repair of functional tricuspid valve regurgitation: one-year follow up.
abstract: OBJECTIVE
  The study aim was to assess the impact of reducing the right ventricular (RV) cavity in order to optimize the outcome of tricuspid valve (TV) repair in cases of functional tricuspid regurgitation (FTR) with dilated right ventricle.
  
  
  METHODS
  Between May 2007 and February 2010, a total of 17 patients (six males, 11 females; mean age 69.5 +/- 10.1 years; mean logistic EuroSCORE 24 +/- 13%) with severe FTR and severe RV dilation were included. Echocardiography and magnetic resonance imaging (MRI) were performed for geometric assessment of the right ventricle. Intraoperatively, the lateral RV free wall was plicated to reduce the RV cavum to approximate the papillary muscles and decrease tethering of the TV; a conventional ring annuloplasty was then performed. Follow up included echocardiography and MRI at one month and one year postoperatively.
  
  
  RESULTS
  The mean operative time was 157 +/- 30 min, and the cross-clamp time 63 13 min. Postoperatively, the mean bleeding volume was 486 +/- 455 ml, the rethoracotomy rate 5.9%, intensive therapy unit (ITU) stay 6.0 +/- 4.4 days, and hospital stay 19.0 +/- 8.8 days. In-hospital mortality was 17.6%. The mean follow up was 14.4 +/- 2.4 months. The one-year follow up revealed a survival of 82.3%, a slight decrease in RV ejection fraction (from 33.5 +/- 4.2% to 31.7 +/- 5.7%; p = 0.13), a significant reduction in the RV end-diastolic volume index (from 160 +/- 15.6 to 128 +/- 10 ml/m2; p = 0.0001), a reduction in TV tenting area (from 3.3 +/- 0.9 to 0.9 +/- 0.3 cm2; p = 0.0001), and a significant reduction in the ratio of TR jet to right atrial surface area (from 54.8 +/- 8.2% to 14.1 +/- 3.5%; p = 0.0001).
  
  
  CONCLUSIONS
  In cases of FTR, RV dilation may be considered as a correctable factor at subvalvular level to optimize the outcome of TV repair.
authors.affiliation: Department of Cardiac Surgery, Dresden Heart Center, Dresden, Germany. dr_a_safwat@hotmail.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ouda
authors.affiliation: Department of Cardiac Surgery, Dresden Heart Center, Dresden, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Matschke
authors.affiliation: Department of Cardiac Surgery, Dresden Heart Center, Dresden, Germany.
authors.forename: Tamer
authors.initials: T
authors.lastname: Ghazy
authors.affiliation: Department of Cardiology, Dresden Heart Center, Dresden, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Speiser
authors.affiliation: Department of Cardiac Surgery, Dresden Heart Center, Dresden, Germany.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Alexiou
authors.affiliation: Department of Cardiac Surgery, Dresden Heart Center, Dresden, Germany.
authors.forename: Sems-Malte
authors.initials: SM
authors.lastname: Tugtekin
authors.affiliation: Department of Cardiology, Dresden Heart Center, Dresden, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Schoen
authors.affiliation: Department of Cardiac Surgery, Dresden Heart Center, Dresden, Germany.
authors.forename: Utz
authors.initials: U
authors.lastname: Kappert
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*