Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery.

Abstract

OBJECTIVE:

The decision to repair mild-to-moderate functional tricuspid regurgitation (TR) during mitral valve surgery remains controversial. We evaluated the effects of tricuspid valve (TV) repair for functional mild-to-moderate TR during mitral valve surgery.

METHODS:

We enrolled 959 patients with mild-to-moderate functional TR who underwent mitral valve surgery with (repair group n = 431) or without (control group n = 528) concomitant TV repair from January 1994 to September 2010.

RESULTS:

There were no significant differences in early mortality or major morbidity rates. Median follow-up was 64.8 months (range, 0.03-203.6 months). After adjustment for baseline characteristics using a propensity score adjustment model, the repair group had similar risks for TV reoperation (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.10-2.07; P = .31); congestive heart failure (HR, 1.12; 95% CI, 0.37-3.36; P = .84); death (HR, 1.41; 95% CI, 0.82-2.42; P = .22); and the composite of death, TV reoperation, and congestive heart failure (HR, 1.24; 95% CI, 0.76-2.03; P = .39) compared with the control group. On multivariate Cox-regression analysis, old age, atrial fibrillation without a Maze procedure, diabetes mellitus, chronic renal failure, poor left ventricular ejection fraction, and redo surgery emerged as significant independent risk factors for the composite outcome of death, TV reoperation, and congestive heart failure.

CONCLUSIONS:

Early or late clinical benefits of concomitant TV repair for mild-to-moderate TR during mitral valve surgery were uncertain through a long-term follow-up of 959 patients. Several preoperative factors and the performance of Maze procedure for AF seem to be more important than TV repair in overall clinical outcomes.

• Authors: Sun Kyun Ro, Joon Bum Kim, Sung Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 146 Issue 5 Pg. 1092-7 (Nov 2013) ISSN: 1097-685X [Electronic] United States
• PMID: 22944085 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Topics

• Adult
• Aged
• Chi-Square Distribution
• Female
• Heart Failure (mortality, surgery)
• Heart Valve Prosthesis Implantation (adverse effects, mortality)
• Humans
• Logistic Models
• Male
• Middle Aged
• Mitral Valve Insufficiency (complications, diagnosis, mortality, surgery)
• Mitral Valve Stenosis (complications, diagnosis, mortality, surgery)
• Multivariate Analysis
• Patient Selection
• Propensity Score
• Proportional Hazards Models
• Reoperation
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Time Factors
• Treatment Outcome
• Tricuspid Valve Insufficiency (complications, diagnosis, mortality, surgery)