Therapeutic strategy for functional tricuspid regurgitation in patients undergoing mitral valve repair for severe mitral regurgitation.
BACKGROUND
The aim of this study was to determine optimal patient selection and selection of a prosthetic ring size for tricuspid valve (TV) repair at the time of mitral valve (MV) repair.


METHODS
We prospectively enrolled 167 consecutive patients undergoing MV repair. TV repair was indicated if patients had at least one of the following conditions representing tricuspid annular dilatation: (1) tricuspid regurgitation (TR)≥moderate, (2) history of right heart failure, (3) atrial fibrillation, and (4) pulmonary hypertension. The size of the ring was targeted to a normal-sized systolic tricuspid annuls in relation to the patient's body surface area (BSA). Serial echocardiographic studies were performed preoperatively, at discharge, and at 1, 3, and 5years postoperatively.


RESULTS
Overall, 100 (60%) patients required TV repair, while it was not indicated for 67 (40%) patients. During follow-up, 26 patients showed progression or recurrent TR≥moderate. The TR grade at 5years after MV surgery was 0.8±0.9 in patients with TV repair and 0.9±0.7 in those without TV repair (P=0.69). There were no significant differences between patients with and without TV repair in a composite endpoint of death from any cause, re-do MV or TV surgery, and recurrence or progression of TR≥moderate (P=0.46).


CONCLUSIONS
Patient selection for TV repair considering not only the grade of TR but clinical signs representing tricuspid annular dilatation is feasible at the time of MV repair. TV repair targeting a normal systolic size in relation to the BSA is a simple and reproducible procedure.
Departments of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minami machi, Chuo-ku, Kobe 650-0047, Japan; Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: kitait@ccf.org.
Takeshi
T
Kitai
Departments of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minami machi, Chuo-ku, Kobe 650-0047, Japan.
Yutaka
Y
Furukawa
Division of Biostatistics, Clinical Research Center Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Japan.
Kenta
K
Murotani
Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
Chayakrit
C
Krittanawong
Departments of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minami machi, Chuo-ku, Kobe 650-0047, Japan.
Shuichiro
S
Kaji
Departments of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minami machi, Chuo-ku, Kobe 650-0047, Japan.
Tadaaki
T
Koyama
Heart Valve Center, Department of Cardiovascular Surgery, Modori Hospital, 1-16 Edayoshi, Nishi-ku, Kobe 651-2133, Japan.
Yukikatsu
Y
Okada
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*
Mitral valve surgery; Tricuspid regurgitation; Tricuspid valve