Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Optimal Tricuspid Annular Size for Tricuspid Annuloplasty in Patients with Less-Than-Moderate Functional Tricuspid Regurgitation

  • Choi, Jae Woong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Kim, Kyung Hwan (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Lim, Su Chan (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Kim, Sue Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Sohn, Suk Ho (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Lee, Yeiwon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Hwang, Ho Young (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital)
  • Received : 2019.09.23
  • Accepted : 2020.06.02
  • Published : 2020.12.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: We evaluated the association between tricuspid annular dilatation and the development of moderate or severe tricuspid regurgitation (TR). Additionally, we determined the optimal tricuspid annular dilatation threshold to use as an indicator for tricuspid annuloplasty in patients with less-than-moderate functional TR (FTR). Methods: Between August 2007 and December 2014, 227 patients with less-than-moderate TR underwent mitral valve surgery without a tricuspid valve (TV) procedure. The TV annular diameter was measured via transthoracic echocardiography. The TV annular index (TVAI) was calculated as the TV annular diameter divided by the body surface area. The mean duration of echocardiographic follow-up was 42.0 months (interquartile range, 9.3-66.6 months). Results: Eight patients (3.5%) developed moderate or severe TR. The rate of freedom from development of moderate or severe TR at 5 years was 96.2%. TV annular diameter, left atrial diameter, preoperative atrial fibrillation, and TVAI were found to be associated with the development of moderate or severe TR in the univariate analysis. A cut-off TVAI value of 19.8 mm/㎡ was found to predict the development of moderate or severe TR, and a significant difference was observed in the development of TR of this severity based on this cut-off (p<0.001). Conclusion: The progression of TR was not infrequent in patients with untreated lessthan-moderate FTR. An aggressive treatment approach can be helpful to prevent the progression of FTR for patients with risk factors, especially TVAI greater than 19.8 mm/㎡.

Keywords

References

  1. Navia JL, Brozzi NA, Klein AL, et al. Moderate tricuspid regurgitation with left-sided degenerative heart valve disease: to repair or not to repair? Ann Thorac Surg 2012;93:59-67. https://doi.org/10.1016/j.athoracsur.2011.08.037
  2. Choe JB, Yun JD, Jeong JW. Tricuspid valve repair in the patients with mitral valve replacement: preoperative and postoperative evaluation by doppler echocardiography. Korean J Thorac Cardiovasc Surg 1991;24:323-30.
  3. Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg 2003;75:1826-8. https://doi.org/10.1016/S0003-4975(03)00028-6
  4. Calafiore AM, Gallina S, Iaco AL, et al. Mitral valve surgery for functional mitral regurgitation: should moderate-or-more tricuspid regurgitation be treated?: a propensity score analysis. Ann Thorac Surg 2009;87:698-703. https://doi.org/10.1016/j.athoracsur.2008.11.028
  5. Song H, Kim MJ, Chung CH, et al. Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery. Heart 2009;95:931-6. https://doi.org/10.1136/hrt.2008.152793
  6. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 2004;43:405-9. https://doi.org/10.1016/j.jacc.2003.09.036
  7. Lee JW, Song JM, Park JP, Lee JW, Kang DH, Song JK. Long-term prognosis of isolated significant tricuspid regurgitation. Circ J 2010;74:375-80. https://doi.org/10.1253/circj.CJ-09-0679
  8. Choi JW, Kim KH, Chang HW, et al. Long-term results of annuloplasty in trivial-to-mild functional tricuspid regurgitation during mitral valve replacement: should we perform annuloplasty on the tricuspid valve or leave it alone? Eur J Cardiothorac Surg 2018;53:756-63. https://doi.org/10.1093/ejcts/ezx395
  9. Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg 2012;143:632-8. https://doi.org/10.1016/j.jtcvs.2011.12.006
  10. Lee H, Sung K, Kim WS, et al. Clinical and hemodynamic influences of prophylactic tricuspid annuloplasty in mechanical mitral valve replacement. J Thorac Cardiovasc Surg 2016;151:788-95. https://doi.org/10.1016/j.jtcvs.2015.10.104
  11. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation 2014;129:e521-643. https://doi.org/10.1161/CIR.0000000000000031
  12. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739-91. https://doi.org/10.1093/eurheartj/ehx391
  13. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16:777-802. https://doi.org/10.1016/S0894-7317(03)00335-3
  14. Van de Veire NR, Braun J, Delgado V, et al. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg 2011;141:1431-9. https://doi.org/10.1016/j.jtcvs.2010.05.050
  15. Altman DG, Lausen B, Sauerbrei W, Schumacher M. Dangers of using "optimal" cutpoints in the evaluation of prognostic factors. J Natl Cancer Inst 1994;86:829-35. https://doi.org/10.1093/jnci/86.11.829
  16. Kusajima K, Fujita T, Hata H, Shimahara Y, Miura S, Kobayashi J. Long-term echocardiographic follow-up of untreated 2+ functional tricuspid regurgitation in patients undergoing mitral valve surgery. Interact Cardiovasc Thorac Surg 2016;23:96-103. https://doi.org/10.1093/icvts/ivw065
  17. Chopra HK, Nanda NC, Fan P, et al. Can two-dimensional echocardiography and Doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol 1989;14:1266-74. https://doi.org/10.1016/0735-1097(89)90426-9
  18. Jouan J, Mele A, Florens E, et al. Conduction disorders after tricuspid annuloplasty with mitral valve surgery: implications for earlier tricuspid intervention. J Thorac Cardiovasc Surg 2016;151:99-103. https://doi.org/10.1016/j.jtcvs.2015.09.063
  19. Badhwar V, Rankin JS, He M, et al. Performing concomitant tricuspid valve repair at the time of mitral valve operations is not associated with increased operative mortality. Ann Thorac Surg 2017;103:587-93. https://doi.org/10.1016/j.athoracsur.2016.06.004