Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets

David Messika-Zeitoun, Helen Thomson, Michael Bellamy, Christopher Scott, Christophe Tribouilloy, Joseph Dearani, A. Jamil Tajik, Hartzell V Schaff, Maurice E Sarano

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Objective We sought to evaluate the medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. Methods We analyzed the cause, clinical presentation, outcome, and natural history of 60 patients with tricuspid regurgitation caused by flail leaflets, a cause of mostly severe and organic tricuspid regurgitation, diagnosed by means of echocardiography between 1980 and 2000. Results The main cause was traumatic (62%). Clinical presentation was often severe: 57% were symptomatic, 33% had a history of congestive heart failure, and 40% had a history of atrial fibrillation. Compared with expected survival of the US matched population, excess mortality (39% ± 10% at 10 years or 4.5% yearly, P < .01) was observed. Even patients asymptomatic at presentation experienced high tricuspid-related event rates (at 10 years, 75% ± 15% had symptoms or heart failure, atrial fibrillation, surgical intervention, or death). In those patients severe enlargement of right-sided chambers was predictive of poor outcome (at 5 years: 86% ± 9% vs 39% ± 11%, P < .01) independent of cause (P = .31). The poor medical outcome was further confirmed by high event rates (69% ± 9% at 15 years) in the natural history beginning from the flail's occurrence. Tricuspid operations were performed in 33 patients (55% ± 7% at 5 years), with valve repair in 82%, low mortality (3%), and, despite frequently refractory atrial fibrillation, symptomatic improvement in 88%. Conclusion Tricuspid regurgitation caused by flail leaflets is a serious disease associated with excess mortality and high morbidity. Tricuspid valve repair can often be performed with low risk, allowing symptomatic improvement. These results suggest that surgical intervention should be considered early in the course of the disease before the occurrence of irreversible consequences.

Original languageEnglish (US)
Pages (from-to)296-302
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume128
Issue number2
DOIs
StatePublished - Aug 2004

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Tricuspid Valve Insufficiency
Atrial Fibrillation
Natural History
Mortality
Heart Failure
Tricuspid Valve
Echocardiography
Morbidity
Survival
Population

Keywords

  • 35

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. / Messika-Zeitoun, David; Thomson, Helen; Bellamy, Michael; Scott, Christopher; Tribouilloy, Christophe; Dearani, Joseph; Tajik, A. Jamil; Schaff, Hartzell V; Sarano, Maurice E.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 128, No. 2, 08.2004, p. 296-302.

Research output: Contribution to journalArticle

Messika-Zeitoun, D, Thomson, H, Bellamy, M, Scott, C, Tribouilloy, C, Dearani, J, Tajik, AJ, Schaff, HV & Sarano, ME 2004, 'Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets', Journal of Thoracic and Cardiovascular Surgery, vol. 128, no. 2, pp. 296-302. https://doi.org/10.1016/j.jtcvs.2004.01.035
Messika-Zeitoun, David ; Thomson, Helen ; Bellamy, Michael ; Scott, Christopher ; Tribouilloy, Christophe ; Dearani, Joseph ; Tajik, A. Jamil ; Schaff, Hartzell V ; Sarano, Maurice E. / Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. In: Journal of Thoracic and Cardiovascular Surgery. 2004 ; Vol. 128, No. 2. pp. 296-302.
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abstract = "Objective We sought to evaluate the medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. Methods We analyzed the cause, clinical presentation, outcome, and natural history of 60 patients with tricuspid regurgitation caused by flail leaflets, a cause of mostly severe and organic tricuspid regurgitation, diagnosed by means of echocardiography between 1980 and 2000. Results The main cause was traumatic (62{\%}). Clinical presentation was often severe: 57{\%} were symptomatic, 33{\%} had a history of congestive heart failure, and 40{\%} had a history of atrial fibrillation. Compared with expected survival of the US matched population, excess mortality (39{\%} ± 10{\%} at 10 years or 4.5{\%} yearly, P < .01) was observed. Even patients asymptomatic at presentation experienced high tricuspid-related event rates (at 10 years, 75{\%} ± 15{\%} had symptoms or heart failure, atrial fibrillation, surgical intervention, or death). In those patients severe enlargement of right-sided chambers was predictive of poor outcome (at 5 years: 86{\%} ± 9{\%} vs 39{\%} ± 11{\%}, P < .01) independent of cause (P = .31). The poor medical outcome was further confirmed by high event rates (69{\%} ± 9{\%} at 15 years) in the natural history beginning from the flail's occurrence. Tricuspid operations were performed in 33 patients (55{\%} ± 7{\%} at 5 years), with valve repair in 82{\%}, low mortality (3{\%}), and, despite frequently refractory atrial fibrillation, symptomatic improvement in 88{\%}. Conclusion Tricuspid regurgitation caused by flail leaflets is a serious disease associated with excess mortality and high morbidity. Tricuspid valve repair can often be performed with low risk, allowing symptomatic improvement. These results suggest that surgical intervention should be considered early in the course of the disease before the occurrence of irreversible consequences.",
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AU - Dearani, Joseph

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N2 - Objective We sought to evaluate the medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. Methods We analyzed the cause, clinical presentation, outcome, and natural history of 60 patients with tricuspid regurgitation caused by flail leaflets, a cause of mostly severe and organic tricuspid regurgitation, diagnosed by means of echocardiography between 1980 and 2000. Results The main cause was traumatic (62%). Clinical presentation was often severe: 57% were symptomatic, 33% had a history of congestive heart failure, and 40% had a history of atrial fibrillation. Compared with expected survival of the US matched population, excess mortality (39% ± 10% at 10 years or 4.5% yearly, P < .01) was observed. Even patients asymptomatic at presentation experienced high tricuspid-related event rates (at 10 years, 75% ± 15% had symptoms or heart failure, atrial fibrillation, surgical intervention, or death). In those patients severe enlargement of right-sided chambers was predictive of poor outcome (at 5 years: 86% ± 9% vs 39% ± 11%, P < .01) independent of cause (P = .31). The poor medical outcome was further confirmed by high event rates (69% ± 9% at 15 years) in the natural history beginning from the flail's occurrence. Tricuspid operations were performed in 33 patients (55% ± 7% at 5 years), with valve repair in 82%, low mortality (3%), and, despite frequently refractory atrial fibrillation, symptomatic improvement in 88%. Conclusion Tricuspid regurgitation caused by flail leaflets is a serious disease associated with excess mortality and high morbidity. Tricuspid valve repair can often be performed with low risk, allowing symptomatic improvement. These results suggest that surgical intervention should be considered early in the course of the disease before the occurrence of irreversible consequences.

AB - Objective We sought to evaluate the medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. Methods We analyzed the cause, clinical presentation, outcome, and natural history of 60 patients with tricuspid regurgitation caused by flail leaflets, a cause of mostly severe and organic tricuspid regurgitation, diagnosed by means of echocardiography between 1980 and 2000. Results The main cause was traumatic (62%). Clinical presentation was often severe: 57% were symptomatic, 33% had a history of congestive heart failure, and 40% had a history of atrial fibrillation. Compared with expected survival of the US matched population, excess mortality (39% ± 10% at 10 years or 4.5% yearly, P < .01) was observed. Even patients asymptomatic at presentation experienced high tricuspid-related event rates (at 10 years, 75% ± 15% had symptoms or heart failure, atrial fibrillation, surgical intervention, or death). In those patients severe enlargement of right-sided chambers was predictive of poor outcome (at 5 years: 86% ± 9% vs 39% ± 11%, P < .01) independent of cause (P = .31). The poor medical outcome was further confirmed by high event rates (69% ± 9% at 15 years) in the natural history beginning from the flail's occurrence. Tricuspid operations were performed in 33 patients (55% ± 7% at 5 years), with valve repair in 82%, low mortality (3%), and, despite frequently refractory atrial fibrillation, symptomatic improvement in 88%. Conclusion Tricuspid regurgitation caused by flail leaflets is a serious disease associated with excess mortality and high morbidity. Tricuspid valve repair can often be performed with low risk, allowing symptomatic improvement. These results suggest that surgical intervention should be considered early in the course of the disease before the occurrence of irreversible consequences.

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