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Original Articles: Adult Cardiac

Clinical and Echocardiographic Impact of Functional Tricuspid Regurgitation Repair at the Time of Mitral Valve Replacement

^a Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada
^b Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
^c Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada

Accepted for publication June 12, 2009.

^_* Address correspondence to Dr Ruel, University of Ottawa Heart Institute, 3403-40 Ruskin St, Ottawa, Ontario, K1Y 4W7, Canada (Email: mruel{at}ottawaheart.ca).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: The indications for tricuspid valve repair in the setting of mitral valve disease and concomitant tricuspid regurgitation (TR) remain unclear. We examined patients undergoing mitral valve replacement (MVR) to determine the effect of TR and tricuspid valve repair on survival, functional status, and postoperative TR.

Methods: Between 1990 and 2005, 624 patients underwent MVR. Data included detailed serial echocardiographic tricuspid valve measurements, functional status, and survival data. Preoperative TR exceeded 2+ in 231: 125 received tricuspid repair and MVR, whereas 106 received MVR alone. Clinical and echocardiographic follow-up were complete (average, 6.8 ± 4.8 years). Parametric and semi-parametric tests were used to analyze outcomes.

Results: TR exceeding 2+ at operation was associated with a 53% increase in late death (p = 0.003). Tricuspid repair prevented echocardiographic progression of TR and improved congestive heart failure symptoms (both p < 0.01). Overall survival did not improve (p = 0.3). A trend to worsening TR in patients was noted with a larger tricuspid annulus diameter and without significant ( 1+) TR preoperatively (odds ratio, 1.4 per cm increase in annulus diameter; p = 0.5), but this was not associated with worse functional or vital outcomes.

Conclusions: In patients undergoing MVR, tricuspid repair is indicated when TR exceeds 2+ to alleviate heart failure symptoms, but without significantly improving survival in this population. TR of 2+ or less may not require repair. Echocardiographic tricuspid annular dimensions alone, in the absence of significant ( 1+) TR preoperatively, should not dictate the performance of tricuspid repair.