Therapeutic strategy for functional tricuspid regurgitation in patients undergoing mitral valve repair for severe mitral regurgitation

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• 作者：Takeshi Kitai^a ; ^e ; ^{kitait@ccf.org} ; Yutaka Furukawa^a ; Kenta Murotani^c ; Chayakrit Krittanawong^e ; Shuichiro Kaji^a ; Tadaaki Koyama^b ; Yukikatsu Okada^d
• 关键词：Mitral valve surgery ; Tricuspid valve ; Tricuspid regurgitation
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：803-807
• 全文大小：533 K
• 卷排序：227

文摘

The aim of this study was to determine optimal patient selection and selection of a prosthetic ring size for tricuspid valve (TV) repair at the time of mitral valve (MV) repair.MethodsWe prospectively enrolled 167 consecutive patients undergoing MV repair. TV repair was indicated if patients had at least one of the following conditions representing tricuspid annular dilatation: (1) tricuspid regurgitation (TR) ≥ moderate, (2) history of right heart failure, (3) atrial fibrillation, and (4) pulmonary hypertension. The size of the ring was targeted to a normal-sized systolic tricuspid annuls in relation to the patient's body surface area (BSA). Serial echocardiographic studies were performed preoperatively, at discharge, and at 1, 3, and 5 years postoperatively.ResultsOverall, 100 (60%) patients required TV repair, while it was not indicated for 67 (40%) patients. During follow-up, 26 patients showed progression or recurrent TR ≥ moderate. The TR grade at 5 years after MV surgery was 0.8 ± 0.9 in patients with TV repair and 0.9 ± 0.7 in those without TV repair (P = 0.69). There were no significant differences between patients with and without TV repair in a composite endpoint of death from any cause, re-do MV or TV surgery, and recurrence or progression of TR ≥ moderate (P = 0.46).ConclusionsPatient selection for TV repair considering not only the grade of TR but clinical signs representing tricuspid annular dilatation is feasible at the time of MV repair. TV repair targeting a normal systolic size in relation to the BSA is a simple and reproducible procedure.