"Prophylactic" tricuspid repair for functional tricuspid regurgitation.
BACKGROUND
The optimal management of functional tricuspid regurgitation (FTR) in the setting of mitral valve operations remains controversial. The objective of this study is to compare the outcomes of congestive heart failure patients who underwent a prophylactic tricuspid operation for FTR as a component of their initial mitral valve procedure with those who underwent a redo tricuspid operation at a later date for residual FTR.


METHODS
Patients with FTR repaired as a redo operation between 2004 and 2012 were identified. These patients were propensity-matched 1:2 with contemporaneous patients with FTR or tricuspid dilatation who underwent tricuspid repair at the same time as mitral valve repair. Demographic information, postoperative complications, and short-term and long-term mortality rates were compared between groups.


RESULTS
There were 21 patients treated with redo tricuspid valve repair matched with 42 patients treated prophylactically. There were 3 deaths at 30 days in the redo group (14%), compared with zero in the prophylactic group (p=0.03). Overall long-term mortality in the redo group was 29% (6 of 21), with a mean 31 months of follow-up, but was only 14% (6 of 42) in the prophylactic group, with a mean 25 months of follow-up. Kaplan-Meier long-term survival analysis did not reveal a difference between groups (log-rank p=0.37) once the perioperative period was survived.


CONCLUSIONS
Redo tricuspid valve repair for residual FTR can be performed with acceptable short-term and long-term mortality. However, treatment of FTR at the time of the initial intervention should be considered, because it is safe and effective. A randomized, controlled trial of prophylactic tricuspid operation for FTR at the time of the mitral operation may be warranted.
Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Nicholas R
NR
Teman
Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Lynn C
LC
Huffman
Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Marguerite
M
Krajacic
Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Francis D
FD
Pagani
Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan.
Jonathan W
JW
Haft
Department of Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: sbolling@med.umich.edu.
Steven F
SF
Bolling
D000368:Aged; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D011322:Primary Prevention / Q000379:methods; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*