Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 141; no. 6; pp. 1431 - 1439
• Main Authors: Van de Veire, Nico R., MD, PhD, Braun, Jerry, MD, Delgado, Victoria, MD, Versteegh, Michel I.M., MD, Dion, Robert A., MD, PhD, Klautz, Robert J.M., MD, PhD, Bax, Jeroen J., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-06-2011; Elsevier
• Subjects: Aged; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Valve Annuloplasty; Cardiology. Vascular system; Cardiothoracic Surgery; Chi-Square Distribution; Dilatation, Pathologic; Disease Progression; Endocardial and cardiac valvular diseases; Female; Heart; Heart Valve Prosthesis Implantation; Humans; Hypertrophy, Right Ventricular - diagnostic imaging; Hypertrophy, Right Ventricular - etiology; Hypertrophy, Right Ventricular - prevention & control; Male; Medical sciences; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Annuloplasty; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - surgery; Netherlands; Pneumology; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency - complications; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - surgery; Ultrasonography; 36.2; tricuspid regurgitation; 35; 36; 35.4.1; TR; Human; Mitral valve; Prognosis; Right ventricle; Cardiovascular disease; Patient; Annuloplasty; Tricuspid regurgitation; Prevention; Cardiac valvular disease; Dilatation; Anesthesia; Evolution; Circulatory system; Cardiology; Tricuspid valve; Mitral valve disease
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2010.05.050

Objectives We hypothesize that concomitant tricuspid annuloplasty in patients with tricuspid annular dilatation who undergo mitral valve repair could prevent progression of tricuspid regurgitation and right ventricular remodeling. Methods In 2002, 80 patients underwent mitral valve repair. Concomitant tricuspid annuloplasty was performed in 13 patients with grade 3 or 4 tricuspid regurgitation. In 2004, 102 patients underwent mitral valve repair. Concomitant tricuspid annuloplasty was performed in 21 patients with grade 3 or 4 tricuspid regurgitation and in 43 patients with an echocardiographically determined tricuspid annular diameter of 40 mm or greater. Patients underwent transthoracic echocardiographic analysis preoperatively and at the 2-year follow-up. Results In the 2002 cohort right ventricular dimensions did not decrease (right ventricular long axis, 69 ± 7 vs 70 ± 8 mm; right ventricular short axis, 29 ± 7 vs 30 ± 7 mm); tricuspid regurgitation grade and gradient remained unchanged. In the 2004 cohort right ventricular reverse remodeling was observed (right ventricular long axis, 71 ± 6 vs 69 ± 9 mm; right ventricular short axis, 29 ± 5 vs 27 ± 5 mm; P  < .0001); tricuspid regurgitation diminished (1.6 ± 1.0 vs 0.9 ± 0.6, P  < .0001), and transtricuspid gradient decreased (28 ± 13 vs 23 ± 15 mm Hg, P  = .021). Subanalysis of the 2002 cohort showed that in 23 patients without grade 3 or 4 tricuspid regurgitation but baseline tricuspid annular dilatation, the degree of tricuspid regurgitation was worse at the 2-year follow-up. Moreover, this caused right ventricular dilatation. Subanalysis of the 2004 cohort demonstrated reverse right ventricular remodeling and decreased tricuspid regurgitation in 43 patients with preoperative tricuspid annular dilatation who underwent tricuspid annuloplasty. Conclusions Concomitant tricuspid annuloplasty during mitral valve repair should be considered in patients with tricuspid annular dilatation despite the absence of important tricuspid regurgitation at baseline because this improves echocardiographic outcome.