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Tricuspid Regurgitation Associated With Ischemic Mitral Regurgitation: Characterization, Evolution After Mitral Surgery, and Value of Tricuspid Repair.
Ann Thorac Surg 2017; 104(2):501-509AT

Abstract

BACKGROUND

Tricuspid regurgitation (TR) often accompanies ischemic mitral regurgitation and is generally assumed to be a secondary consequence of altered hemodynamics of the left-sided regurgitation. We hypothesized that it may also be a direct consequence of right-sided ischemic disease. Therefore, our objectives were to (1) characterize the nature of this TR and (2) describe its time course after mitral valve surgery for ischemic mitral regurgitation, with or without concomitant tricuspid valve repair.

METHODS

From 2001 to 2011, 568 patients with ischemic mitral regurgitation underwent mitral valve surgery. They had varying degrees of TR and altered right-side heart morphology and function; 131 had concomitant tricuspid valve repair. Postoperatively, 1,395 echocardiograms were available to assess residual and recurrent TR.

RESULTS

Greater severity of preoperative TR was accompanied by larger tricuspid valve diameter, greater leaflet tethering, worse right ventricular function, and higher right ventricular pressure (all p [trend] ≤ 0.002). Without tricuspid valve repair, 31% of patients with no preoperative TR had moderate or greater TR by 5 years, as did 62% with moderate TR. With tricuspid valve repair, 25% with moderate preoperative TR remained in that grade at 5 years, but 11% had severe TR.

CONCLUSIONS

Tricuspid regurgitation accompanying ischemic mitral regurgitation is associated with right-side heart remodeling and dysfunction often mirroring that occurring in the left side of the heart-ischemic TR. Tricuspid valve repair is effective initially, but as with mitral valve repair, TR progressively returns. Therefore, when the severity of TR and right-sided remodeling reaches the point of irreversibility, it may be an indication to eliminate the TR by replacing the tricuspid valve.

Authors+Show Affiliations

Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: naviaj@ccf.org.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28223050

Citation

Navia, José L., et al. "Tricuspid Regurgitation Associated With Ischemic Mitral Regurgitation: Characterization, Evolution After Mitral Surgery, and Value of Tricuspid Repair." The Annals of Thoracic Surgery, vol. 104, no. 2, 2017, pp. 501-509.
Navia JL, Elgharably H, Javadikasgari H, et al. Tricuspid Regurgitation Associated With Ischemic Mitral Regurgitation: Characterization, Evolution After Mitral Surgery, and Value of Tricuspid Repair. Ann Thorac Surg. 2017;104(2):501-509.
Navia, J. L., Elgharably, H., Javadikasgari, H., Ibrahim, A., Koprivanac, M., Lowry, A. M., ... Svensson, L. G. (2017). Tricuspid Regurgitation Associated With Ischemic Mitral Regurgitation: Characterization, Evolution After Mitral Surgery, and Value of Tricuspid Repair. The Annals of Thoracic Surgery, 104(2), pp. 501-509. doi:10.1016/j.athoracsur.2016.11.024.
Navia JL, et al. Tricuspid Regurgitation Associated With Ischemic Mitral Regurgitation: Characterization, Evolution After Mitral Surgery, and Value of Tricuspid Repair. Ann Thorac Surg. 2017;104(2):501-509. PubMed PMID: 28223050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tricuspid Regurgitation Associated With Ischemic Mitral Regurgitation: Characterization, Evolution After Mitral Surgery, and Value of Tricuspid Repair. AU - Navia,José L, AU - Elgharably,Haytham, AU - Javadikasgari,Hoda, AU - Ibrahim,Ahmed, AU - Koprivanac,Marijan, AU - Lowry,Ashley M, AU - Blackstone,Eugene H, AU - Klein,Allan L, AU - Gillinov,A Marc, AU - Roselli,Eric E, AU - Svensson,Lars G, Y1 - 2017/02/21/ PY - 2016/01/27/received PY - 2016/09/02/revised PY - 2016/11/17/accepted PY - 2017/2/23/pubmed PY - 2017/9/7/medline PY - 2017/2/23/entrez SP - 501 EP - 509 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 104 IS - 2 N2 - BACKGROUND: Tricuspid regurgitation (TR) often accompanies ischemic mitral regurgitation and is generally assumed to be a secondary consequence of altered hemodynamics of the left-sided regurgitation. We hypothesized that it may also be a direct consequence of right-sided ischemic disease. Therefore, our objectives were to (1) characterize the nature of this TR and (2) describe its time course after mitral valve surgery for ischemic mitral regurgitation, with or without concomitant tricuspid valve repair. METHODS: From 2001 to 2011, 568 patients with ischemic mitral regurgitation underwent mitral valve surgery. They had varying degrees of TR and altered right-side heart morphology and function; 131 had concomitant tricuspid valve repair. Postoperatively, 1,395 echocardiograms were available to assess residual and recurrent TR. RESULTS: Greater severity of preoperative TR was accompanied by larger tricuspid valve diameter, greater leaflet tethering, worse right ventricular function, and higher right ventricular pressure (all p [trend] ≤ 0.002). Without tricuspid valve repair, 31% of patients with no preoperative TR had moderate or greater TR by 5 years, as did 62% with moderate TR. With tricuspid valve repair, 25% with moderate preoperative TR remained in that grade at 5 years, but 11% had severe TR. CONCLUSIONS: Tricuspid regurgitation accompanying ischemic mitral regurgitation is associated with right-side heart remodeling and dysfunction often mirroring that occurring in the left side of the heart-ischemic TR. Tricuspid valve repair is effective initially, but as with mitral valve repair, TR progressively returns. Therefore, when the severity of TR and right-sided remodeling reaches the point of irreversibility, it may be an indication to eliminate the TR by replacing the tricuspid valve. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/28223050/Tricuspid_Regurgitation_Associated_With_Ischemic_Mitral_Regurgitation:_Characterization_Evolution_After_Mitral_Surgery_and_Value_of_Tricuspid_Repair_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(16)31626-5 DB - PRIME DP - Unbound Medicine ER -