We aimed to investigate the prevalence and predictors of postoperative tricuspid regurgitation
(TR) worsening in patients with mitral regurgitation (MR) and concomitant ≤mild TR.
A total of 620 patients underwent surgery for MR from 2013 to 2017. Of these, 260
had ≤mild preoperative TR and no concomitant tricuspid valve surgery and were enrolled
in this single-center retrospective study. The primary endpoint was postoperative
worsening of ≥moderate TR. The primary endpoint occurred in 28 of 260 patients (11%)
during the follow-up period [median: 4.1 years (interquartile range: 2.9−6.1 years)].
In the multivariable analysis, age, female sex, and left atrial volume index (LAVI)
were significant predictors of the primary outcome during intermediate-term follow-up
(age: hazard ratio [HR] 1.05 per 1-year increment, 95% confidence interval [CI] 1.02–1.10,
p = 0.003; female sex: HR 3.53, 95% CI 1.61–7.72, p = 0.002; LAVI: HR 1.17 per 10-mL/m2 increment, 95% CI 1.07−1.26, p < 0.001). The optimal LAVI cut-off value for predicting
postoperative TR worsening was 79 mL/m2 (area under the curve: 0.69). A high LAVI (>79 mL/m²) was significantly associated
with a low rate of freedom from postoperative TR worsening compared with a low LAVI
(≤79 mL/m²) (82.6% vs. 93.9% at 5 years, respectively; log-rank p = 0.008). In patients
with ≤mild preoperative TR and no concomitant tricuspid surgery, the rate of postoperative
TR worsening was 11% during intermediate-term follow-up. LA enlargement in patients
with MR and ≤mild preoperative TR was significantly associated with postoperative
TR worsening.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
TR (tricuspid regurgitation), MR (mitral regurgitation), AF (atrial fibrillation), TA (tricuspid annulus), TAD (tricuspid annulus diameter), LAD (left atrial diameter), LAVI (left atrial volume index), TRPG (tricuspid regurgitation pressure gradient)To read this article in full you will need to make a payment
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References
- Burden of tricuspid regurgitation in patients diagnosed in the community setting.J Am Coll Cardiol Img. 2019; 12: 433-442
- Development of significant tricuspid regurgitation over time and prognostic implications: new insights into natural history.Eur Heart J. 2018; 39: 3574-3581
- Functional tricuspid regurgitation of degenerative mitral valve disease: a crucial determinant of survival.Eur Heart J. 2020; 41: 1918-1929
- Progression of isolated tricuspid regurgitation late after left-sided valve surgery. Clinical features and mechanisms.Circ J. 2011; 75: 2902-2907
- Natural history of coexistent tricuspid regurgitation in patients with degenerative mitral valve disease: implications for future guidelines.J Thorac Cardiovasc Surg. 2014; 148: 2802-2809
- Definitive determinant of late significant tricuspid regurgitation after aortic valve replacement.Circ J. 2018; 82: 886-894
- 2021 ESC/EACTS Guidelines for the management of valvular heart disease.Eur Heart J. 2022; 43: 561-632
- 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2021; 143: e72-e227
- JCS/JSCS/JATS/JSVS 2020 Guidelines on the management of valvular heart disease.Circ J. 2020; 84: 2037-2119
- Concomitant tricuspid repair in patients with degenerative mitral regurgitation.N Engl J Med. 2022; 386: 327-339
- Predictors of residual tricuspid regurgitation after mitral valve surgery.Ann Thorac Surg. 2003; 75: 1826-1828
- Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery.Heart. 2009; 95: 931-936
- Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair?.Ann Thorac Surg. 2005; 79: 127-132
- 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC.Eur Heart J. 2021; 42: 373-498
- Tricuspid regurgitation secondary to mitral valve disease: tricuspid annulus function as guide to tricuspid valve repair.Cardiovasc Surg. 2001; 9: 369-377
- Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery.J Thorac Cardiovasc Surg. 2012; 143: 632-638
- Tricuspid annulus diameter does not predict the development of tricuspid regurgitation after mitral valve repair for mitral regurgitation due to degenerative diseases.J Thorac Cardiovasc Surg. 2018; 155: 2429-2436
- Evolution of tricuspid regurgitation after mitral valve surgery for patients with moderate-or-less functional tricuspid regurgitation.Heart Surg Forum. 2012; 15: E121-E126
- Echocardiographic-based treatment of functional tricuspid regurgitation.J Thorac Cardiovasc Surg. 2011; 142: 308-313
- Long-term outcome of combined valve repair and maze procedure for nonrheumatic mitral regurgitation.J Thorac Cardiovasc Surg. 2010; 140: 1332-1337
- Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.J Am Soc Echocardiogr. 2005; 18: 1440-1463
- Recommendations for the evaluation of left ventricular diastolic function by echocardiography.J Am Soc Echocardiogr. 2009; 22: 107-133
- Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography.J Am Soc Echocardiogr. 2003; 16: 777-802
- Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.J Am Soc Echocardiogr. 2010; 23 (quiz 786-788): 685-713
- Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations.Am Heart J. 2008; 155: 732-737
- Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease.J Heart Valve Dis. 2002; 11: 353-356
- Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study).Am J Cardiol. 1999; 83: 897-902
- Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation.J Heart Valve Dis. 1999; 8: 57-62
- Epidemiology of diastolic heart failure.Prog Cardiovasc Dis. 2005; 47: 320-332
- Prevalence of atrial fibrillation in the general population of Japan: an analysis based on periodic health examination.Int J Cardiol. 2009; 137: 102-107
- Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets: results from a large international multicenter study.Circ Cardiovasc Imaging. 2011; 4: 473-481
- Prognostic value of left atrial volume in asymptomatic organic mitral regurgitation.J Am Soc Echocardiogr. 2013; 26: 699-705
- Influence of left atrial function on exercise capacity and left ventricular function in patients with heart failure and preserved ejection fraction.Circ Cardiovasc Imaging. 2017; 10e005467
- The relationship of atrial fibrillation and tricuspid annular dilation to late tricuspid regurgitation in patients with degenerative mitral repair.J Thorac Cardiovasc Surg. 2021; 161: 2030-2040
- Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study.Eur Heart J. 2012; 33: 2644-2652
Article info
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In Press Journal Pre-ProofFootnotes
Disclosure Statement: All authors have nothing to disclose.
Funding Statement: All authors have no funding.
Institutional Review Board (IRB) Approval: R19095; approval number: 19-322; approval date: 28 December 2019
Informed Consent Statement: This study was classified as a non-interventional study because it did not use invasive procedures or human-derived specimens; thus, the requirement for informed consent was waived. However, the details of the study were disseminated to patients and their families/caregivers, with the opportunity for patients to decline study participation (opt-out).
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