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


METHODS
We 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 5years postoperatively.


RESULTS
Overall, 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 5years 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).


CONCLUSIONS
Patient 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.
['Kitai|Takeshi|T|', 'Furukawa|Yutaka|Y|', 'Murotani|Kenta|K|', 'Krittanawong|Chayakrit|C|', 'Kaji|Shuichiro|S|', 'Koyama|Tadaaki|T|', 'Okada|Yukikatsu|Y|']
D000328:Adult D000368:Aged D005260:Female D005500:Follow-Up Studies D019918:Heart Valve Prosthesis Implantation D006801:Humans D008297:Male D008875:Middle Aged D008943:Mitral Valve D008944:Mitral Valve Insufficiency D011446:Prospective Studies D016896:Treatment Outcome D014262:Tricuspid Valve Insufficiency
Tricuspid regurgitation Tricuspid valve Mitral valve surgery