Influence of mitral valve repair versus replacement on the development of late functional tricuspid regurgitation

Bijoy G. Rajbanshi, Rakesh M. Suri, Vuyisile T Nkomo, Joseph A. Dearani, Richard C. Daly, Harold M. Burkhart, John M. Stulak, Lyle D. Joyce, Zhuo Li, Hartzell V Schaff

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Abstract

Objectives To study the determinants of functional tricuspid regurgitation (TR) progression after surgical correction of mitral regurgitation, including the influence of mitral valve (MV) repair (MVr) versus replacement (MVR) for degenerative mitral regurgitation.

Methods From January 1995 to January 2006, 747 adults with MV prolapse underwent isolated MVr (n = 683) or MVR (n = 64; mechanical in 32). The mean age was 60.8 years, and 491 were men (66.0%). Moderate preoperative functional TR was present in 115 (15.4%). The MVR group had a greater likelihood of New York Heart Association class III or IV (75.0% vs 34.4%, P <.001), atrial fibrillation (20.3% vs 8.3%, P =.002), a lower left ventricular ejection fraction (61.0% vs 65.2%, P <.003), and a higher pulmonary artery pressure (50.1 vs 41.2 mm Hg, P =.001). The patients were monitored for a mean of 6.9 years (MVr) or 7.7 years (MVR; P =.075).

Results During late follow-up, no difference was found between the groups in the development of moderately severe or severe TR: 1 to 5 years (3.0% vs 3.3%, P =.91) and >5 years (6.1% vs 6.5%; P =.93). The univariate predictors of severe TR after 5 years were older age (hazard ratio [HR], 1.1; P =.011), female gender (HR, 6.86; P =.005), higher pulmonary artery pressure (HR, 1.05; P =.022), and larger left atrial size (HR, 2.11; P =.035). Two patients (0.26%) who had undergone initial MVr required reoperation for late functional TR. Another 2 patients had had the tricuspid valve addressed concurrent with reoperation for MVr failure. No tricuspid reoperations were required in the MVR group.

Conclusions The risk of TR progression was low after MVr or MVR for MV prolapse. Timely MV surgery before the development of left atrial dilatation or pulmonary hypertension could further decrease the risk of TR progression during follow-up.

Original languageEnglish (US)
Pages (from-to)1957-1962
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number5
DOIs
StatePublished - Nov 1 2014

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Tricuspid Valve Insufficiency
Mitral Valve
Reoperation
Mitral Valve Prolapse
Mitral Valve Insufficiency
Tricuspid Valve
Pulmonary Hypertension
Pulmonary Artery
Dilatation
Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Influence of mitral valve repair versus replacement on the development of late functional tricuspid regurgitation. / Rajbanshi, Bijoy G.; Suri, Rakesh M.; Nkomo, Vuyisile T; Dearani, Joseph A.; Daly, Richard C.; Burkhart, Harold M.; Stulak, John M.; Joyce, Lyle D.; Li, Zhuo; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 5, 01.11.2014, p. 1957-1962.

Research output: Contribution to journalArticle

Rajbanshi, Bijoy G. ; Suri, Rakesh M. ; Nkomo, Vuyisile T ; Dearani, Joseph A. ; Daly, Richard C. ; Burkhart, Harold M. ; Stulak, John M. ; Joyce, Lyle D. ; Li, Zhuo ; Schaff, Hartzell V. / Influence of mitral valve repair versus replacement on the development of late functional tricuspid regurgitation. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 148, No. 5. pp. 1957-1962.
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title = "Influence of mitral valve repair versus replacement on the development of late functional tricuspid regurgitation",
abstract = "Objectives To study the determinants of functional tricuspid regurgitation (TR) progression after surgical correction of mitral regurgitation, including the influence of mitral valve (MV) repair (MVr) versus replacement (MVR) for degenerative mitral regurgitation.Methods From January 1995 to January 2006, 747 adults with MV prolapse underwent isolated MVr (n = 683) or MVR (n = 64; mechanical in 32). The mean age was 60.8 years, and 491 were men (66.0{\%}). Moderate preoperative functional TR was present in 115 (15.4{\%}). The MVR group had a greater likelihood of New York Heart Association class III or IV (75.0{\%} vs 34.4{\%}, P <.001), atrial fibrillation (20.3{\%} vs 8.3{\%}, P =.002), a lower left ventricular ejection fraction (61.0{\%} vs 65.2{\%}, P <.003), and a higher pulmonary artery pressure (50.1 vs 41.2 mm Hg, P =.001). The patients were monitored for a mean of 6.9 years (MVr) or 7.7 years (MVR; P =.075).Results During late follow-up, no difference was found between the groups in the development of moderately severe or severe TR: 1 to 5 years (3.0{\%} vs 3.3{\%}, P =.91) and >5 years (6.1{\%} vs 6.5{\%}; P =.93). The univariate predictors of severe TR after 5 years were older age (hazard ratio [HR], 1.1; P =.011), female gender (HR, 6.86; P =.005), higher pulmonary artery pressure (HR, 1.05; P =.022), and larger left atrial size (HR, 2.11; P =.035). Two patients (0.26{\%}) who had undergone initial MVr required reoperation for late functional TR. Another 2 patients had had the tricuspid valve addressed concurrent with reoperation for MVr failure. No tricuspid reoperations were required in the MVR group.Conclusions The risk of TR progression was low after MVr or MVR for MV prolapse. Timely MV surgery before the development of left atrial dilatation or pulmonary hypertension could further decrease the risk of TR progression during follow-up.",
author = "Rajbanshi, {Bijoy G.} and Suri, {Rakesh M.} and Nkomo, {Vuyisile T} and Dearani, {Joseph A.} and Daly, {Richard C.} and Burkhart, {Harold M.} and Stulak, {John M.} and Joyce, {Lyle D.} and Zhuo Li and Schaff, {Hartzell V}",
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T1 - Influence of mitral valve repair versus replacement on the development of late functional tricuspid regurgitation

AU - Rajbanshi, Bijoy G.

AU - Suri, Rakesh M.

AU - Nkomo, Vuyisile T

AU - Dearani, Joseph A.

AU - Daly, Richard C.

AU - Burkhart, Harold M.

AU - Stulak, John M.

AU - Joyce, Lyle D.

AU - Li, Zhuo

AU - Schaff, Hartzell V

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Objectives To study the determinants of functional tricuspid regurgitation (TR) progression after surgical correction of mitral regurgitation, including the influence of mitral valve (MV) repair (MVr) versus replacement (MVR) for degenerative mitral regurgitation.Methods From January 1995 to January 2006, 747 adults with MV prolapse underwent isolated MVr (n = 683) or MVR (n = 64; mechanical in 32). The mean age was 60.8 years, and 491 were men (66.0%). Moderate preoperative functional TR was present in 115 (15.4%). The MVR group had a greater likelihood of New York Heart Association class III or IV (75.0% vs 34.4%, P <.001), atrial fibrillation (20.3% vs 8.3%, P =.002), a lower left ventricular ejection fraction (61.0% vs 65.2%, P <.003), and a higher pulmonary artery pressure (50.1 vs 41.2 mm Hg, P =.001). The patients were monitored for a mean of 6.9 years (MVr) or 7.7 years (MVR; P =.075).Results During late follow-up, no difference was found between the groups in the development of moderately severe or severe TR: 1 to 5 years (3.0% vs 3.3%, P =.91) and >5 years (6.1% vs 6.5%; P =.93). The univariate predictors of severe TR after 5 years were older age (hazard ratio [HR], 1.1; P =.011), female gender (HR, 6.86; P =.005), higher pulmonary artery pressure (HR, 1.05; P =.022), and larger left atrial size (HR, 2.11; P =.035). Two patients (0.26%) who had undergone initial MVr required reoperation for late functional TR. Another 2 patients had had the tricuspid valve addressed concurrent with reoperation for MVr failure. No tricuspid reoperations were required in the MVR group.Conclusions The risk of TR progression was low after MVr or MVR for MV prolapse. Timely MV surgery before the development of left atrial dilatation or pulmonary hypertension could further decrease the risk of TR progression during follow-up.

AB - Objectives To study the determinants of functional tricuspid regurgitation (TR) progression after surgical correction of mitral regurgitation, including the influence of mitral valve (MV) repair (MVr) versus replacement (MVR) for degenerative mitral regurgitation.Methods From January 1995 to January 2006, 747 adults with MV prolapse underwent isolated MVr (n = 683) or MVR (n = 64; mechanical in 32). The mean age was 60.8 years, and 491 were men (66.0%). Moderate preoperative functional TR was present in 115 (15.4%). The MVR group had a greater likelihood of New York Heart Association class III or IV (75.0% vs 34.4%, P <.001), atrial fibrillation (20.3% vs 8.3%, P =.002), a lower left ventricular ejection fraction (61.0% vs 65.2%, P <.003), and a higher pulmonary artery pressure (50.1 vs 41.2 mm Hg, P =.001). The patients were monitored for a mean of 6.9 years (MVr) or 7.7 years (MVR; P =.075).Results During late follow-up, no difference was found between the groups in the development of moderately severe or severe TR: 1 to 5 years (3.0% vs 3.3%, P =.91) and >5 years (6.1% vs 6.5%; P =.93). The univariate predictors of severe TR after 5 years were older age (hazard ratio [HR], 1.1; P =.011), female gender (HR, 6.86; P =.005), higher pulmonary artery pressure (HR, 1.05; P =.022), and larger left atrial size (HR, 2.11; P =.035). Two patients (0.26%) who had undergone initial MVr required reoperation for late functional TR. Another 2 patients had had the tricuspid valve addressed concurrent with reoperation for MVr failure. No tricuspid reoperations were required in the MVR group.Conclusions The risk of TR progression was low after MVr or MVR for MV prolapse. Timely MV surgery before the development of left atrial dilatation or pulmonary hypertension could further decrease the risk of TR progression during follow-up.

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