Mitral Valve Repair Without Repair of Moderate Tricuspid Regurgitation.
BACKGROUND
The objective of this study was to assess the fate at long term of mild-to-moderate functional tricuspid regurgitation (TR) left untreated at the time of mitral valve repair in patients with dilated cardiomyopathy.


METHODS
We selected from our prospective hospital database 84 patients (age, 64 ± 9.6 years; ejection fraction, 0.31 ± 0.064) who underwent mitral repair for secondary mitral regurgitation in whom concomitant mild-to-moderate TR (nonlinear scale 1 to 4+) was left untreated. Tricuspid regurgitation was classified as mild in 61 patients (72.6%) and moderate in 23 patients (27.3%). Annular dilatation itself was not systematically measured and was not used as a trigger for tricuspid annuloplasty. Most of the patients were in New York Heart Association functional class III or IV (56 of 84; 66.7%).


RESULTS
At a median follow-up of 7.3 years (interquartile range, 4.5 to 9.3), 17 patients (20.2%) had moderate-to-severe TR and 21 patients (25%) showed a progression of at least two grades of their untreated preoperative TR. Freedom from moderate-to-severe TR or from progression of at least two grades of the baseline TR was 77% ± 5% at 5 years and 56.7% ± 8.4% at 10 years. Multivariate analysis identified preoperative right ventricular dysfunction (hazard ratio, 7.2; 95% confidence interval, 2.8 to 23; p = 0.001) and age (hazard ratio, 1; 95% confidence interval, 1.0 1.1; p = 0.03) as independent predictors of TR worsening.


CONCLUSIONS
A significant number of dilated cardiomyopathy patients with mild-to-moderate TR left untreated at the time of mitral repair show important TR at follow-up. In this setting, a more aggressive policy should be used taking into consideration the degree of annular dilatation and the function of the right ventricle and not simply the grade of TR.
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: michele.debonis@hsr.it.
Michele
M
De Bonis
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Elisabetta
E
Lapenna
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Alberto
A
Pozzoli
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Teodora
T
Nisi
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Andrea
A
Giacomini
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Mariachiara
M
Calabrese
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Giovanni
G
La Canna
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Federico
F
Pappalardo
Department of Cardiac Surgery, Fondazione Toscana Gabriele Monasterio, Massa, Italy.
Antonio
A
Miceli
Department of Cardiac Surgery, Fondazione Toscana Gabriele Monasterio, Massa, Italy.
Mattia
M
Glauber
Department of Cardiac Surgery, Santa Croce e Carle Hospital, Cuneo, Italy.
Fabio
F
Barili
Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Ottavio
O
Alfieri
D018450:Disease Progression; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology*; D020257:Ventricular Remodeling