Accepted Manuscript The Influence of Mitral Valve Repair versus Replacement Upon the Development Of Late Functional Tricuspid Regurgitation Bijoy G. Rajbanshi, MBBS Rakesh M. Suri, MD, D.Phil Vuyisile T. Nkomo, MD, MPH Joseph A. Dearani, MD Richard C. Daly, MD Harold M. Burkhart, MD John M. Stulak, MD Lyle D. Joyce, MD, PhD Zhuo Li, MS Hartzell V. Schaff, MD PII:
S0022-5223(14)00515-7
DOI:
10.1016/j.jtcvs.2014.04.041
Reference:
YMTC 8580
To appear in:
The Journal of Thoracic and Cardiovascular Surgery
Received Date: 13 September 2013 Revised Date:
12 April 2014
Accepted Date: 18 April 2014
Please cite this article as: Rajbanshi BG, Suri RM, Nkomo VT, Dearani JA, Daly RC, Burkhart HM, Stulak JM, Joyce LD, Li Z, Schaff HV, The Influence of Mitral Valve Repair versus Replacement Upon the Development Of Late Functional Tricuspid Regurgitation, The Journal of Thoracic and Cardiovascular Surgery (2014), doi: 10.1016/j.jtcvs.2014.04.041. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
The Influence of Mitral Valve Repair versus Replacement Upon the Development Of Late Functional Tricuspid Regurgitation
RI PT
Bijoy G Rajbanshi MBBSa, Rakesh M Suri MD, D.Phila, Vuyisile T Nkomo MD, MPHb, Joseph A Dearani MDa, Richard C Daly MDa, Harold M Burkhart MDa,
SC
John M Stulak MDa, Lyle D Joyce MD, PhDa, Zhuo Li MSc, Hartzell V Schaff MDa
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
b
Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
c
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester,
M AN U
a
TE D
Minnesota
Author of Correspondence
EP
Rakesh M Suri, MD. D.Phil.
Division of Cardiovascular Surgery
AC C
Mayo Clinic
200 First Street SW
Rochester, MN 55905 [email protected]
ACCEPTED MANUSCRIPT
Objectives: To study the determinants of functional tricuspid regurgitation (TR) progression following surgical correction of mitral regurgitation (MR) including the
RI PT
influence of repair versus replacement for degenerative mitral regurgitation.
Methods: From January 1995 to January 2006, 747 adults with MV prolapse
underwent isolated mitral repair(N=683) or replacement(N=64, mechanical=32).
SC
Mean age was 60.8yrs and 491(66.0%) were men. Moderate preoperative
functional TR was present in 115(15.4%). Mitral replacement patients had a
M AN U
higher likelihood of NYHA class III/IV status (75.0 vs. 34.4%,p = 5 years. All statistical
TE D
tests were two-sided with the alpha level set at 0.05 for statistical significance
Results
EP
Baseline
Six hundred and eighty three patients (91.4%) underwent MVr while 64 (8.6%)
AC C
patients had MVR. There were 491 (66.0%) males and 256 (34.0%) females. Preoperative demographics are listed in Table 1. There were slight differences between the two groups with MVR patients being older (65.7±13.4 vs. 60.4±13.7, p value 0.002), and more likely to have NYHA Class III/IV symptoms (75.0% vs. 34.4%, p value 57 mm, right ventricle end systolic diameter is >55 and pulmonary artery pressure above 58
RI PT
mm Hg.(22) Our study was not designed to test this recommendation.
Unfortunately, there are no robust methods to predict which patients will develop progression or regression of functional TR. Repair of moderate functional TR is
SC
an ACC/AHA guideline Class IIB recommendation when associated with pulmonary hypertension or annular dilatation based upon level of evidence C
M AN U
while it is IIA indication when associated with dilated annulus as a concomitant procedure according to ESC guidelines.(24, 25) Various authors have advocated tricuspid valve repair when annular dilatation exists.(15, 19, 21) Groves et al. suggested that once the annulus is enlarged, minimal further increase is
TE D
associated with a significant progression of TR.(26) Thus treating the mitral valve lesion alone in such patients only reduces the afterload and does not necessarily alter TV annular dilatation or improve RV function and thus would not eliminate
EP
the substrate for the persistence or progression of TR.(4) Although we did not historically measure TV annular dimension, patients were included in our current
AC C
study if they had normal right ventricular size and function. The derived conclusions are thus applicable to this specific population of patients.
The limitations of the current study are consistent with its retrospective nature. A prospective randomized study is not plausible as repair continues to be the preferred procedure to replacement and recent evidence suggests that mitral
ACCEPTED MANUSCRIPT
valve repair in the absence of symptoms improves long term survival.(27) While we followed the TR on clinically indicated echocardiograms, it is possible that those with significant TR evaded detection, however this possibility is unlikely
RI PT
due to the typically robust follow up in our referral network and the fact that right heart failure associated with severe TR is typically detected on physical examination. Further, while NYHA data captures functional performance related
SC
to left heart failure symptoms, right heart failure symptoms are admittedly more difficult to quantify. Patients seen in follow up in our valvular heart disease clinics
heart function is routinely performed.
TE D
Conclusion
M AN U
have echocardiograms readily available and assessment of both left and right
Moderate or less tricuspid regurgitation in patients undergoing isolated surgical correction of degenerative mitral valve regurgitation is unlikely to progress in the
EP
absence of concomitant cardiac disease, right heart failure, increased left atrial size or pulmonary hypertension. The risk of onset or progression of TR is
AC C
similarly low following mitral repair or replacement. Age, Sex and timing of mitral valve surgery may influence progression of functional TR, however definitive conclusions will necessarily await the incorporation of additional markers of chronicity in future analyses.
ACCEPTED MANUSCRIPT
References:
1.
Messika-Zeitoun D, Thomson H, Bellamy M, Scott C, Tribouilloy C,
Dearani J, et al. Medical and surgical outcome of tricuspid regurgitation caused thoracic and cardiovascular surgery.
RI PT
by flail leaflets. The Journal of 2004;128(2):296-302. Epub 2004/07/30. 2.
Calafiore AM, Gallina S, Iaco AL, Contini M, Bivona A, Gagliardi M, et al.
Mitral valve surgery for functional mitral regurgitation: should moderate-or-more
SC
tricuspid regurgitation be treated? a propensity score analysis. The Annals of thoracic surgery. 2009;87(3):698-703. Epub 2009/02/24.
Desai RR, Vargas Abello LM, Klein AL, Marwick TH, Krasuski RA, Ye Y,
M AN U
3.
et al. Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. The Journal of thoracic and cardiovascular surgery. 2012. Epub 2012/09/27. 4.
Anyanwu AC, Chikwe J, Adams DH. Tricuspid valve repair for treatment
and prevention of secondary tricuspid regurgitation in patients undergoing mitral
5.
TE D
valve surgery. Current cardiology reports. 2008;10(2):110-7. Epub 2008/04/18. Rogers JH, Bolling SF. The tricuspid valve: current perspective and
evolving management of tricuspid regurgitation. Circulation. 2009;119(20):271825. Epub 2009/05/28.
Song JM, Kang DH, Song JK, Jeong YH, Lee CW, Hong MK, et al.
EP
6.
Outcome of significant functional tricuspid regurgitation after percutaneous mitral
7.
AC C
valvuloplasty. American heart journal. 2003;145(2):371-6. Epub 2003/02/22. Braunwald NS, Ross J, Jr., Morrow AG. Conservative management of
tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation. 1967;35(4 Suppl):I63-9. Epub 1967/04/01. 8.
Chan V, Burwash IG, Lam BK, Auyeung T, Tran A, Mesana TG, et al.
Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement. The Annals of thoracic surgery. 2009;88(4):1209-15. Epub 2009/09/22.
ACCEPTED MANUSCRIPT
9.
Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on
long-term
survival.
Journal
of
the
American
College
of
Cardiology.
2004;43(3):405-9. Epub 2004/03/12. 10.
Anyanwu AC, Adams DH. Functional tricuspid regurgitation in mitral valve
cardiovascular surgery. 2010;22(1):69-75. Epub 2010/09/04. 11.
RI PT
disease: epidemiology and prognostic implications. Seminars in thoracic and
King RM, Schaff HV, Danielson GK, Gersh BJ, Orszulak TA, Piehler JM,
et al. Surgery for tricuspid regurgitation late after mitral valve replacement.
12.
SC
Circulation. 1984;70(3 Pt 2):I193-7. Epub 1984/09/01.
Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T.
M AN U
Predictors of residual tricuspid regurgitation after mitral valve surgery. The Annals of thoracic surgery. 2003;75(6):1826-8. Epub 2003/06/26. 13.
Matsunaga A, Duran CM. Progression of tricuspid regurgitation after
repaired functional ischemic mitral regurgitation. Circulation. 2005;112(9 Suppl):I453-7. Epub 2005/09/15. 14.
Yilmaz O, Suri RM, Dearani JA, Sundt TM, 3rd, Daly RC, Burkhart HM, et
TE D
al. Functional tricuspid regurgitation at the time of mitral valve repair for degenerative leaflet prolapse: the case for a selective approach. The Journal of thoracic and cardiovascular surgery. 2011;142(3):608-13. Epub 2011/02/01. 15.
Benedetto U, Melina G, Angeloni E, Refice S, Roscitano A, Comito C, et
EP
al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. The Journal of thoracic and cardiovascular
16.
AC C
surgery. 2012;143(3):632-8. Epub 2012/01/17. Porter A, Shapira Y, Wurzel M, Sulkes J, Vaturi M, Adler Y, et al. Tricuspid
regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. The Journal of heart valve disease. 1999;8(1):57-62. Epub 1999/03/30. 17.
Kim JB, Yoo DG, Kim GS, Song H, Jung SH, Choo SJ, et al. Mild-to-
moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair
ACCEPTED MANUSCRIPT
on clinical and echocardiographic outcomes. Heart. 2012;98(1):24-30. Epub 2011/09/21. 18.
Taramasso M, Vanermen H, Maisano F, Guidotti A, La Canna G, Alfieri O.
The growing clinical importance of secondary tricuspid regurgitation. Journal of
19.
RI PT
the American College of Cardiology. 2012;59(8):703-10. Epub 2012/02/22.
Dreyfus GD, Corbi PJ, Chan KM, Bahrami T. Secondary tricuspid
regurgitation or dilatation: which should be the criteria for surgical repair? The Annals of thoracic surgery. 2005;79(1):127-32. Epub 2004/12/29.
Ro SK, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Mild-to-moderate
SC
20.
functional tricuspid regurgitation in patients undergoing mitral valve surgery. The
21.
M AN U
Journal of thoracic and cardiovascular surgery. 2012. Epub 2012/09/05. Shinn SH, Schaff HV. Evidence-based surgical management of acquired
tricuspid valve disease. Nature reviews Cardiology. 2013;10(4):190-203. Epub 2013/02/13. 22.
He J, Shen Z, Yu Y, Huang H, Ye W, Ding Y, et al. Criteria for determining
the need for surgical treatment of tricuspid regurgitation during mitral valve
23.
TE D
replacement. Journal of cardiothoracic surgery. 2012;7:27. Epub 2012/03/27. Stulak JM, Schaff HV, Dearani JA, Orszulak TA, Daly RC, Sundt TM, 3rd.
Restoration of sinus rhythm by the Maze procedure halts progression of tricuspid regurgitation after mitral surgery. The Annals of thoracic surgery. 2008;86(1):40-
24.
EP
4; discussion 4-5. Epub 2008/06/25.
Bonow RO, Carabello BA, Kanu C, de Leon AC, Jr., Faxon DP, Freed MD,
AC C
et al. ACC/AHA 2006 guidelines 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 (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114(5):e84-231. Epub 2006/08/02.
ACCEPTED MANUSCRIPT
25.
Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et
al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. European heart journal. 2007;28(2):230-68. Epub 2007/01/30. Groves PH, Lewis NP, Ikram S, Maire R, Hall RJ. Reduced exercise
RI PT
26.
capacity in patients with tricuspid regurgitation after successful mitral valve replacement
for
rheumatic
mitral
valve
disease.
1991;66(4):295-301. Epub 1991/10/01.
heart
journal.
Suri RM, Vanoverschelde JL, Grigioni F, Schaff HV, Tribouilloy C,
SC
27.
British
Avierinos JF, et al. Association between early surgical intervention vs watchful
M AN U
waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets. JAMA : the journal of the American Medical Association. 2013;310(6):609-16.
AC C
EP
TE D
Epub 2013/08/15.
ACCEPTED MANUSCRIPT
Legends
Table 2. Intra-operative and Post-operative Characteristics
RI PT
Table 1. Patient Charecteristics
SC
Table 3. Comparison of Post operative presence of MR, TR and symptoms
M AN U
between MV repair and replacement
AC C
EP
TE D
Table 4. Risk Factors for development of Late Grade IV Tricuspid Regurgitation
ACCEPTED MANUSCRIPT
Table 1. Patient Characteristics All Patients
P value
60.4 ± 13.7,
65.7 ± 13.4,
0.002
Male
491 (66%)
450 (65.9%)
41 (64.1%)
0.770
Female
256 (34%)
233 (34.1%)
23 (35.9%)
Class I & II
464 (62.1%)
448 (65.6%)
16 (25%)
Class III & IV
283 (37.9%)
235 (34.4%)
48 (75%)
Hypertension
288 (39%)
270 (39.5%)
18 (28.1%)
0.073
Diabetes
19 (3%)
18 (2.6%)
1 (1.6%)
0.602
Preoperative Atrial Fibrillation
70 (9%)
57 (8.3%)
13 (20.3)%
0.002
EF (%)
64.9 ± 7.8,
65.2 ± 7.6,
61.0 ± 9.8,
0.003
57.8 ± 7.1,
58.1 ± 6.3,
53.0 ± 15.1
0.101
32.8 ± 11.5
0.814
0.790
EP
LVEDD (mm)
LVESD (mm)
AC C
Mitral Regurgitation Tricuspid valve regurgitation – Preoperative
RVSP (mmHg)
Grade III
SC
NYHA Class
M AN U
Gender
RI PT
60.8 ± 13.7
TE D
Age (years)
MV repair MV = 683 replaceme nt = 64
35.3 ± 7.1 35.4 ± 5.9
S0022-5223(14)00515-7
DOI:
10.1016/j.jtcvs.2014.04.041
Reference:
YMTC 8580
To appear in:
The Journal of Thoracic and Cardiovascular Surgery
Received Date: 13 September 2013 Revised Date:
12 April 2014
Accepted Date: 18 April 2014
Please cite this article as: Rajbanshi BG, Suri RM, Nkomo VT, Dearani JA, Daly RC, Burkhart HM, Stulak JM, Joyce LD, Li Z, Schaff HV, The Influence of Mitral Valve Repair versus Replacement Upon the Development Of Late Functional Tricuspid Regurgitation, The Journal of Thoracic and Cardiovascular Surgery (2014), doi: 10.1016/j.jtcvs.2014.04.041. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
The Influence of Mitral Valve Repair versus Replacement Upon the Development Of Late Functional Tricuspid Regurgitation
RI PT
Bijoy G Rajbanshi MBBSa, Rakesh M Suri MD, D.Phila, Vuyisile T Nkomo MD, MPHb, Joseph A Dearani MDa, Richard C Daly MDa, Harold M Burkhart MDa,
SC
John M Stulak MDa, Lyle D Joyce MD, PhDa, Zhuo Li MSc, Hartzell V Schaff MDa
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
b
Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
c
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester,
M AN U
a
TE D
Minnesota
Author of Correspondence
EP
Rakesh M Suri, MD. D.Phil.
Division of Cardiovascular Surgery
AC C
Mayo Clinic
200 First Street SW
Rochester, MN 55905 [email protected]
ACCEPTED MANUSCRIPT
Objectives: To study the determinants of functional tricuspid regurgitation (TR) progression following surgical correction of mitral regurgitation (MR) including the
RI PT
influence of repair versus replacement for degenerative mitral regurgitation.
Methods: From January 1995 to January 2006, 747 adults with MV prolapse
underwent isolated mitral repair(N=683) or replacement(N=64, mechanical=32).
SC
Mean age was 60.8yrs and 491(66.0%) were men. Moderate preoperative
functional TR was present in 115(15.4%). Mitral replacement patients had a
M AN U
higher likelihood of NYHA class III/IV status (75.0 vs. 34.4%,p = 5 years. All statistical
TE D
tests were two-sided with the alpha level set at 0.05 for statistical significance
Results
EP
Baseline
Six hundred and eighty three patients (91.4%) underwent MVr while 64 (8.6%)
AC C
patients had MVR. There were 491 (66.0%) males and 256 (34.0%) females. Preoperative demographics are listed in Table 1. There were slight differences between the two groups with MVR patients being older (65.7±13.4 vs. 60.4±13.7, p value 0.002), and more likely to have NYHA Class III/IV symptoms (75.0% vs. 34.4%, p value 57 mm, right ventricle end systolic diameter is >55 and pulmonary artery pressure above 58
RI PT
mm Hg.(22) Our study was not designed to test this recommendation.
Unfortunately, there are no robust methods to predict which patients will develop progression or regression of functional TR. Repair of moderate functional TR is
SC
an ACC/AHA guideline Class IIB recommendation when associated with pulmonary hypertension or annular dilatation based upon level of evidence C
M AN U
while it is IIA indication when associated with dilated annulus as a concomitant procedure according to ESC guidelines.(24, 25) Various authors have advocated tricuspid valve repair when annular dilatation exists.(15, 19, 21) Groves et al. suggested that once the annulus is enlarged, minimal further increase is
TE D
associated with a significant progression of TR.(26) Thus treating the mitral valve lesion alone in such patients only reduces the afterload and does not necessarily alter TV annular dilatation or improve RV function and thus would not eliminate
EP
the substrate for the persistence or progression of TR.(4) Although we did not historically measure TV annular dimension, patients were included in our current
AC C
study if they had normal right ventricular size and function. The derived conclusions are thus applicable to this specific population of patients.
The limitations of the current study are consistent with its retrospective nature. A prospective randomized study is not plausible as repair continues to be the preferred procedure to replacement and recent evidence suggests that mitral
ACCEPTED MANUSCRIPT
valve repair in the absence of symptoms improves long term survival.(27) While we followed the TR on clinically indicated echocardiograms, it is possible that those with significant TR evaded detection, however this possibility is unlikely
RI PT
due to the typically robust follow up in our referral network and the fact that right heart failure associated with severe TR is typically detected on physical examination. Further, while NYHA data captures functional performance related
SC
to left heart failure symptoms, right heart failure symptoms are admittedly more difficult to quantify. Patients seen in follow up in our valvular heart disease clinics
heart function is routinely performed.
TE D
Conclusion
M AN U
have echocardiograms readily available and assessment of both left and right
Moderate or less tricuspid regurgitation in patients undergoing isolated surgical correction of degenerative mitral valve regurgitation is unlikely to progress in the
EP
absence of concomitant cardiac disease, right heart failure, increased left atrial size or pulmonary hypertension. The risk of onset or progression of TR is
AC C
similarly low following mitral repair or replacement. Age, Sex and timing of mitral valve surgery may influence progression of functional TR, however definitive conclusions will necessarily await the incorporation of additional markers of chronicity in future analyses.
ACCEPTED MANUSCRIPT
References:
1.
Messika-Zeitoun D, Thomson H, Bellamy M, Scott C, Tribouilloy C,
Dearani J, et al. Medical and surgical outcome of tricuspid regurgitation caused thoracic and cardiovascular surgery.
RI PT
by flail leaflets. The Journal of 2004;128(2):296-302. Epub 2004/07/30. 2.
Calafiore AM, Gallina S, Iaco AL, Contini M, Bivona A, Gagliardi M, et al.
Mitral valve surgery for functional mitral regurgitation: should moderate-or-more
SC
tricuspid regurgitation be treated? a propensity score analysis. The Annals of thoracic surgery. 2009;87(3):698-703. Epub 2009/02/24.
Desai RR, Vargas Abello LM, Klein AL, Marwick TH, Krasuski RA, Ye Y,
M AN U
3.
et al. Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. The Journal of thoracic and cardiovascular surgery. 2012. Epub 2012/09/27. 4.
Anyanwu AC, Chikwe J, Adams DH. Tricuspid valve repair for treatment
and prevention of secondary tricuspid regurgitation in patients undergoing mitral
5.
TE D
valve surgery. Current cardiology reports. 2008;10(2):110-7. Epub 2008/04/18. Rogers JH, Bolling SF. The tricuspid valve: current perspective and
evolving management of tricuspid regurgitation. Circulation. 2009;119(20):271825. Epub 2009/05/28.
Song JM, Kang DH, Song JK, Jeong YH, Lee CW, Hong MK, et al.
EP
6.
Outcome of significant functional tricuspid regurgitation after percutaneous mitral
7.
AC C
valvuloplasty. American heart journal. 2003;145(2):371-6. Epub 2003/02/22. Braunwald NS, Ross J, Jr., Morrow AG. Conservative management of
tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation. 1967;35(4 Suppl):I63-9. Epub 1967/04/01. 8.
Chan V, Burwash IG, Lam BK, Auyeung T, Tran A, Mesana TG, et al.
Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement. The Annals of thoracic surgery. 2009;88(4):1209-15. Epub 2009/09/22.
ACCEPTED MANUSCRIPT
9.
Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on
long-term
survival.
Journal
of
the
American
College
of
Cardiology.
2004;43(3):405-9. Epub 2004/03/12. 10.
Anyanwu AC, Adams DH. Functional tricuspid regurgitation in mitral valve
cardiovascular surgery. 2010;22(1):69-75. Epub 2010/09/04. 11.
RI PT
disease: epidemiology and prognostic implications. Seminars in thoracic and
King RM, Schaff HV, Danielson GK, Gersh BJ, Orszulak TA, Piehler JM,
et al. Surgery for tricuspid regurgitation late after mitral valve replacement.
12.
SC
Circulation. 1984;70(3 Pt 2):I193-7. Epub 1984/09/01.
Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T.
M AN U
Predictors of residual tricuspid regurgitation after mitral valve surgery. The Annals of thoracic surgery. 2003;75(6):1826-8. Epub 2003/06/26. 13.
Matsunaga A, Duran CM. Progression of tricuspid regurgitation after
repaired functional ischemic mitral regurgitation. Circulation. 2005;112(9 Suppl):I453-7. Epub 2005/09/15. 14.
Yilmaz O, Suri RM, Dearani JA, Sundt TM, 3rd, Daly RC, Burkhart HM, et
TE D
al. Functional tricuspid regurgitation at the time of mitral valve repair for degenerative leaflet prolapse: the case for a selective approach. The Journal of thoracic and cardiovascular surgery. 2011;142(3):608-13. Epub 2011/02/01. 15.
Benedetto U, Melina G, Angeloni E, Refice S, Roscitano A, Comito C, et
EP
al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. The Journal of thoracic and cardiovascular
16.
AC C
surgery. 2012;143(3):632-8. Epub 2012/01/17. Porter A, Shapira Y, Wurzel M, Sulkes J, Vaturi M, Adler Y, et al. Tricuspid
regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. The Journal of heart valve disease. 1999;8(1):57-62. Epub 1999/03/30. 17.
Kim JB, Yoo DG, Kim GS, Song H, Jung SH, Choo SJ, et al. Mild-to-
moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair
ACCEPTED MANUSCRIPT
on clinical and echocardiographic outcomes. Heart. 2012;98(1):24-30. Epub 2011/09/21. 18.
Taramasso M, Vanermen H, Maisano F, Guidotti A, La Canna G, Alfieri O.
The growing clinical importance of secondary tricuspid regurgitation. Journal of
19.
RI PT
the American College of Cardiology. 2012;59(8):703-10. Epub 2012/02/22.
Dreyfus GD, Corbi PJ, Chan KM, Bahrami T. Secondary tricuspid
regurgitation or dilatation: which should be the criteria for surgical repair? The Annals of thoracic surgery. 2005;79(1):127-32. Epub 2004/12/29.
Ro SK, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Mild-to-moderate
SC
20.
functional tricuspid regurgitation in patients undergoing mitral valve surgery. The
21.
M AN U
Journal of thoracic and cardiovascular surgery. 2012. Epub 2012/09/05. Shinn SH, Schaff HV. Evidence-based surgical management of acquired
tricuspid valve disease. Nature reviews Cardiology. 2013;10(4):190-203. Epub 2013/02/13. 22.
He J, Shen Z, Yu Y, Huang H, Ye W, Ding Y, et al. Criteria for determining
the need for surgical treatment of tricuspid regurgitation during mitral valve
23.
TE D
replacement. Journal of cardiothoracic surgery. 2012;7:27. Epub 2012/03/27. Stulak JM, Schaff HV, Dearani JA, Orszulak TA, Daly RC, Sundt TM, 3rd.
Restoration of sinus rhythm by the Maze procedure halts progression of tricuspid regurgitation after mitral surgery. The Annals of thoracic surgery. 2008;86(1):40-
24.
EP
4; discussion 4-5. Epub 2008/06/25.
Bonow RO, Carabello BA, Kanu C, de Leon AC, Jr., Faxon DP, Freed MD,
AC C
et al. ACC/AHA 2006 guidelines 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 (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114(5):e84-231. Epub 2006/08/02.
ACCEPTED MANUSCRIPT
25.
Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, et
al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. European heart journal. 2007;28(2):230-68. Epub 2007/01/30. Groves PH, Lewis NP, Ikram S, Maire R, Hall RJ. Reduced exercise
RI PT
26.
capacity in patients with tricuspid regurgitation after successful mitral valve replacement
for
rheumatic
mitral
valve
disease.
1991;66(4):295-301. Epub 1991/10/01.
heart
journal.
Suri RM, Vanoverschelde JL, Grigioni F, Schaff HV, Tribouilloy C,
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27.
British
Avierinos JF, et al. Association between early surgical intervention vs watchful
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waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets. JAMA : the journal of the American Medical Association. 2013;310(6):609-16.
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Epub 2013/08/15.
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Legends
Table 2. Intra-operative and Post-operative Characteristics
RI PT
Table 1. Patient Charecteristics
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Table 3. Comparison of Post operative presence of MR, TR and symptoms
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between MV repair and replacement
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Table 4. Risk Factors for development of Late Grade IV Tricuspid Regurgitation
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Table 1. Patient Characteristics All Patients
P value
60.4 ± 13.7,
65.7 ± 13.4,
0.002
Male
491 (66%)
450 (65.9%)
41 (64.1%)
0.770
Female
256 (34%)
233 (34.1%)
23 (35.9%)
Class I & II
464 (62.1%)
448 (65.6%)
16 (25%)
Class III & IV
283 (37.9%)
235 (34.4%)
48 (75%)
Hypertension
288 (39%)
270 (39.5%)
18 (28.1%)
0.073
Diabetes
19 (3%)
18 (2.6%)
1 (1.6%)
0.602
Preoperative Atrial Fibrillation
70 (9%)
57 (8.3%)
13 (20.3)%
0.002
EF (%)
64.9 ± 7.8,
65.2 ± 7.6,
61.0 ± 9.8,
0.003
57.8 ± 7.1,
58.1 ± 6.3,
53.0 ± 15.1
0.101
32.8 ± 11.5
0.814
0.790
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LVEDD (mm)
LVESD (mm)
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Mitral Regurgitation Tricuspid valve regurgitation – Preoperative
RVSP (mmHg)
Grade III
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NYHA Class
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Gender
RI PT
60.8 ± 13.7
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Age (years)
MV repair MV = 683 replaceme nt = 64
35.3 ± 7.1 35.4 ± 5.9
