Back to Search
Start Over
Early failure of tricuspid annuloplasty. Should we repair the tricuspid valve at an earlier stage? The role of right ventricle and tricuspid apparatus.
- Source :
-
Journal of Cardiac Surgery . Jun2019, Vol. 34 Issue 6, p404-411. 8p. 2 Charts, 3 Graphs. - Publication Year :
- 2019
-
Abstract
- <bold>Background: </bold>We sought to identify subgroups of patients at a higher probability of tricuspid annuloplasty (TAP) failure early after surgery.<bold>Methods: </bold>From May 2009 to December 2015, 688 patients undergoing TAP for functional tricuspid regurgitation (FTR) at a single institution were included in the study. In all patients, a complete transthoracic echocardiographic evaluation of right ventricle (RV) and tricuspid valve (TV) apparatus was collected.<bold>Results: </bold>Twenty-six patients (3.8%) died within the first 30 days of surgery. Residual TR after TAP was recorded in 85 (12.4%), moderate in 80 (11.7%) and severe in 5 (0.7%). Preoperative TV apparatus remodeling was associated with residual TR; in particular, the following cutoffs were identified: TV coaptation depth ≥6.5 mm, tenting area ≥0.85 cm2 , and tricuspid annulus ≥35 mm. The entire cohort was stratified in three subsets: patients having preoperative mild/moderate TR without preoperative TV apparatus and/or RV remodeling (n = 178); patients having mild/moderate TR with TV apparatus and/or RV remodeling (n = 317); patients with severe TR regardless of TV apparatus and/or RV remodeling (n = 193). Residual TR was 2.8%, 10.4%, and 24.3%, respectively (P < 0.001). At multivariable analysis, patients showing preoperative mild/moderate TR with TV apparatus and/or RV remodeling as well as patients with severe TR were at significantly higher risk for early failure. No difference was found regarding the type of TV repair performed.<bold>Conclusions: </bold>Prophylactic TAP should be encouraged among surgeons even earlier than guidelines recommend, and decision-making for the treatment of low-grade FTR at the time of left-sided valve surgery should take into consideration not only annular size but also tethering severity and RV dilatation. [ABSTRACT FROM AUTHOR]
- Subjects :
- *TRICUSPID valve
*TRICUSPID valve surgery
*VENTRICULAR remodeling
Subjects
Details
- Language :
- English
- ISSN :
- 08860440
- Volume :
- 34
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Journal of Cardiac Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 136805639
- Full Text :
- https://doi.org/10.1111/jocs.14042