Does moderate tricuspid regurgitation require attention during mitral valve surgery?

Yeates, A., Marwick, T., Deva, R., Mundy, J., Wood, A., Griffin, R., Peters, P. and Shah, P. (2014) Does moderate tricuspid regurgitation require attention during mitral valve surgery?. ANZ Journal of Surgery, 84 1-2: 63-67. doi:10.1111/ans.12068

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Author Yeates, A.
Marwick, T.
Deva, R.
Mundy, J.
Wood, A.
Griffin, R.
Peters, P.
Shah, P.
Title Does moderate tricuspid regurgitation require attention during mitral valve surgery?
Journal name ANZ Journal of Surgery   Check publisher's open access policy
ISSN 1445-1433
Publication date 2014-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1111/ans.12068
Open Access Status
Volume 84
Issue 1-2
Start page 63
End page 67
Total pages 5
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject 2746 Surgery
Abstract Background: This study aims to determine whether tricuspid regurgitation (TR) ≥ 2+ requires attention during mitral valve surgery. Methods: From April 1999 to 2009, 161 patients undergoing primary, isolated mitral valve procedures were assessed. Preoperative moderate TR (≥2+) was present in 56 of 161 patients and tricuspid valve repair (TVR: ring annuloplasty) was carried out on 22 of 56 patients with TR ≥ 2+. Baseline echocardiogram included TR severity (ASE criteria), TR velocity, estimated right atrial pressure, visual assessment of right ventricular failure and strain. Follow-up was 47 ± 33 months (96% complete); 91 of 161 patients overall (57%) and 44 of 45 patients with TR ≥ 2+ had follow-up echocardiogram. Results: Patients with moderate TR had worse baseline functional class and operative risks, both worst in the non-TVR group. Overall mortality was 15% (n = 23), comprising 2.5% (4/161) 30-day mortality and 12% (9/157) late death. Poorer preoperative TR was associated with worse survival by univariate analysis (P = 0.046), after correction for right ventricular function and pulmonary artery pressure (P = 0.049), age and diabetes (P = 0.041). Despite lower risk of TR ≥ 2+ with TVR, 5-year survival was 42%, which was less than TR < 2+ and that of non-TVR group (90%, P = 0.003). Improvement in overall functional class (NYHA) was better in the non-TVR group (TVR: preoperative 2.1 ± 1.5; post-operative 1.2 ± 1.1 (P = 0.02) versus non-TVR: preoperative 1.8 ± 1.4, post-operative 1.2 ± 0.9 (P < 0.0001)). There was no difference in quality of life (QOL) indices (SF-36 questionnaire) at follow-up between patients with TR < 2+ and TR ≥ 2+ preoperatively, or across all levels of TR before or after surgical repair. Conclusions: Preoperative TR ≥ 2+, non-TVR group had more favourable functional class and mid-term survival with comparable QOL and echocardiographic parameters to the TVR group.
Keyword Functional class
Mitral valve surgery
Quality of life
Tricuspid valve
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 20 JAN 2013

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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