Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy

De Bonis, Michele; Lapenna, Elisabetta; Sorrentino, Flavia; La Canna, Giovanni; Grimaldi, Antonio; Maisano, Francesco; Torracca, Lucia; Alfieri, Ottavio
April 2008
European Journal of Cardio-Thoracic Surgery;Apr2008, Vol. 33 Issue 4, p600
Academic Journal
Abstract: Objective: To assess the evolution of tricuspid regurgitation (TR) in dilated cardiomyopathy (DCM) patients submitted to mitral repair for functional mitral regurgitation (MR). Methods: Ninety-one DCM patients (mean age 61±11.3) submitted to MV repair (±tricuspid repair) for functional MR were included. Preoperative EF was 30.9±6.5%, left ventricular (LV) end-diastolic volume 113±31.5ml/m2, LV end-systolic volume 81.8±26.7ml/m2, functional MR ≥3+/4+. TR was classified as ≤1+/4+ in 57 patients (62.6%), 2+/4+ in 21 (23%) and ≥3+/4+ in 13 (14.2%). Most of the patients were in NYHA class III or IV. A tricuspid annuloplasty was associated to mitral repair whenever preoperative TR was ≥3+. Therefore 13 patients (14.2%) underwent concomitant tricuspid annuloplasty whereas the remaining 78 (with preoperative TR ≤2+) did not. Results: At follow-up (mean 1.8±1.2 years), 12% of the patients (11/91) had still 3–4+ TR due to failure of the tricuspid repair or progression of untreated ≤2+ TR. Freedom from TR ≥3+ was 78±8.8% at 3.5 years. Among the 78 patients not submitted to tricuspid repair, 14 (18%) showed a progression of TR severity equal or greater than two grades. The multivariate analysis identified grade of TR at discharge (OR 5.4, p =0.01) and preoperative RV dysfunction (OR 19.6, p =0.02) as the only independent predictors of TR ≥3+/4+ at follow-up. Conclusions: A significant number of patients submitted to mitral repair for functional MR present ≥3+ TR at follow-up as consequence of progression of untreated TR or failure of tricuspid repair. A more aggressive and effective treatment of functional TR in this setting should be pursued.


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