Surgical Treatment for Isolated Tricuspid Regurgitation after Left-Sided Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WEIDa-chuang , HUANGHuan-lei , LUCong , ZHENGShao-yi , LIUJing , GUOHui-ming , HUANGJin-song , FANRui-xin ,  XIAOXue-jun

Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, P. R. China;

Corresponding author：

XIAOXue-jun, Email: xiaoxuejun2012@163.com

Keywords：

Left-sided valve replacement; Tricuspid regurgitation; Tricuspid valve replacement; Tricuspid valvuloplasty

DOI：

10.7507/1007-4848.20140054

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Objective To analyze risk factors and long-term outcomes of surgical treatment for isolated tricuspid regurgitation (TR) after left-sided valve replacement. Methods We retrospectively analyzed clinical data of 65 patients who underwent surgical treatment for severe isolated TR after left-sided valve replacement in Guangdong Cardiovascular Institute from January 2000 to June 2013. There were 12 male and 53 female patients with their age of 37-72 (52.3±8.0) years. Fifty-nine patients had atrial fibrillation (AF). There were 61 patients with functional TR and 4 patients with rheumatic TR. Six patients were in New York Heart Association (NYHA) functional class Ⅱ,40 patients were in NYHA class Ⅲ,and 19 patients were in NYHA class Ⅳ.The duration between the first and second cardiac operation was 1-26 (11.2±4.7) years. Fifty-five patients received tricuspid valve replacement (TVR) and 10 patients received tricuspid valvuloplasty (TVP). Results Eleven patients (16.9%) died postoperatively. Univariate analysis showed that male gender,right ventricular internal dimension,preoperative serum albumin level (ALB) direct bilirubin (DBil) level,cardiopulmonary bypass (CPB) time and preoperative NYHA functional class Ⅳ were significantly correlated with postoperative death. Preoperative cardiothoracic ratio(C/T) TR area,left ventricular ejection fraction (LVEF) pulmonary arterial systolic pressure (PAs) preoperative hemoglobin(HGB) level,creatinine (Cr) level,total bilirubin (TBil) level,alanine aminotransferase (ALT) level and the duration between the first and second cardiac operation were not significantly related with surgical mortality. Multivariate logistic regression analysis showed that preoperative NYHA functional class Ⅳ was an independent risk factor of in-hospital death (OR=7.23,95% CI:1.57-33.25,P=0.01). Among the 54 survivors,50 patients (92.6%) were followed up for 1-160(47.2±43.3) months. Five patients died during follow-up including 3 TVR patients with heart failure,1 TVR patient with aortic valve obstruction and 1 TVP patient with sudden cardiac arrest. One-year and 5-year survival rates of TVR patients were 95%±3% and 89%±7% respectively,and 1-year and 5-year survival rates of TVP patients were 100% and 80%±18% respectively(P=0.92). Cox regression analysis showed that preoperative Cr level was an independent risk factor of long-term mortality (HR=1.10,95% CI:1.03-1.17,P<0.01). Conclusion In-hospital mortality of patients with isolated TR after left-sided valve replacement who undergo surgical treatment is significantly related with preoperative overall condition and heart function. Surgical therapy should be performed before severe heart failure occurs. Postoperative 5-year survival rate is good,and long-term mortality is related with preoperative Cr level.

Citation： WEIDa-chuang, HUANGHuan-lei, LUCong, ZHENGShao-yi, LIUJing, GUOHui-ming, HUANGJin-song, FANRui-xin, XIAOXue-jun. Surgical Treatment for Isolated Tricuspid Regurgitation after Left-Sided Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 178-183. doi: 10.7507/1007-4848.20140054 Copy

1.	肖锡俊,袁宏声,唐红,等.二尖瓣置换术后三尖瓣反流的逆转、残留或加重.中国胸心血管外科临床杂志,2006,13 (5):307-310.
2.	Ruel M,Rubens FD,Masters RG,et al.Late incidence and predictors of persistent or recurrent heart failure in patients with mitral prosthetic valves.J Thorac Cardiovasc Surg,2004,128 (2):278-283.
3.	Kwak JJ,Kim YJ,Kim MK,et al.Development of tricuspid regurgitation late after left-sided valve surgery:a single-center experience with long-term echocardiographic examinations.Am Heart J,2008,155 (4):732-737.
4.	Matsuyama K,Matsumoto M,Sugita T,et al.Predictors of residual tricuspid regurgitation after mitral valve surgery.Ann Thorac Surg,2003,75 (6):1826-1828.
5.	Izumi C,Miyake M,Takahashi S,et al.Progression of isolated tricuspid regurgitation late after left-sided valve surgery.Clinical features and mechanisms.Circ J,2011,75 (12):2902-2907.
6.	Matsunaga A,Duran CM.Progression of tricuspid regurgitation after repaired functional ischemic mitral regurgitation.Circulation,2005,112 (9 Suppl):I453-I457.
7.	Spinner EM,Lerakis S,Higginson J,et al.Correlates of tricuspid regurgitation as determined by 3D echocardiography:pulmonary arterial pressure,ventricle geometry,annular dilatation,and papillary muscle displacement.Circ Cardiovasc Imaging,2012,5 (1):43-50.
8.	Benedetto U,Melina G,Angeloni E,et al.Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery.J Thorac Cardiovasc Surg,2012,143 (3):632-638.
9.	Katsi V,Raftopoulos L,Aggeli C,et al.Tricuspid regurgitation after successful mitral valve surgery.Interact Cardiovasc Thorac Surg,2012,15 (1):102-108.
10.	Spinner EM,Shannon P,Buice D,et al.In vitro characterization of the mechanisms responsible for functional tricuspid regurgitation.Circulation,2011,124 (8):920-929.
11.	Vargas Abello LM,Klein AL,Marwick TH,et al.Understanding right ventricular dysfunction and functional tricuspid regurgitation accompanying mitral valve disease.J Thorac Cardiovasc Surg,2013,145 (5):1234-1241.
12.	Seo HS,Ha JW,Moon JY,et al.Right ventricular remodeling and dysfunction with subsequent annular dilatation and tethering as a mechanism of isolated tricuspid regurgitation.Circ J,2008,72 (10):1645-1649.
13.	Yoo JS,Kim JB,Jung SH,et al.Impact of the maze procedure and postoperative atrial fibrillation on progression of functional tricuspid regurgitation in patients undergoing degenerative mitral repair.Eur J Cardiothorac Surg,2013,43 (3):520-525.
14.	Song H,Kim MJ,Chung CH,et al.Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery.Heart,2009,95 (11):931-936.
15.	Je HG,Song H,Jung SH,et al.Impact of the maze operation on the progression of mild functional tricuspid regurgitation.J Thorac Cardiovasc Surg,2008,136 (5):1187-1192.
16.	Stulak JM,Schaff HV,Dearani JA,et al.Restoration of sinus rhythm by the Maze procedure halts progression of tricuspid regurgitation after mitral surgery.Ann Thorac Surg,2008,86 (1):40-45.
17.	Kim HK,Kim YJ,Kim KI,et al.Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time.Circulation,2005,112 (9 Suppl):I14-I19.
18.	Pfannmüller B,Moz M,Misfeld M,et al.Isolated tricuspid valve surgery in patients with previous cardiac surgery.J Thorac Cardiovasc Surg,2013,146 (4):841-847.
19.	Chen SW,Tsai FC,Tsai FC,et al.Surgical risk and outcome of repair versus replacement for late tricuspid regurgitation in redo operation.Ann Thorac Surg,2012,93 (3):770-775.
20.	Park K,Kim HK,Kim YJ,et al.Incremental prognostic value of early ostoperative right ventricular systolic function in patients undergoing surgery for isolated severe tricuspid regurgitation.Heart,2011,97 (16):1319-1325.
21.	Topilsky Y,Khanna AD,Oh JK,et al.Preoperative factors associated with adverse outcome after tricuspid valve replacement.Circulation,2011,123 (18):1929-1939.
22.	Kim YJ,Kwon DA,Kim HK,et al.Determinants of surgical outcome in patients with isolated tricuspid regurgitation.Circulation,2009,120 (17):1672-1678.
23.	Xiao XJ,Huang HL,Zhang JF,et al.Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement.Heart Lung Circ,2004,13 (1):65-69.
24.	肖学钧,何竞功,卢聪,等.左心瓣膜置换术后远期三尖瓣关闭不全的外科治疗.中国胸心血管外科临床杂志,2003,10 (4):298-299.
25.	Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC),European Association for Cardio-Thoracic Surgery (EACTS),Vahanian A,et al.Guidelines on the management of valvular heart disease (version 2012).Eur Heart J,2012,33 (19):2451-2496.
26.	Nishimura RA,Carabello BA,Faxon DP,et al.Acc/aha 2008 guideline update on valvular heart disease:focused update on infective endocarditis:a report of the american college of cardiology/american heart association task force on practice guidelines:endorsed by the society of cardiovascular anesthesiologists,society for cardiovascular angiography and interventions,and society of thoracic surgeons.Circulation,2008,118 (8):887-896.

1. 肖锡俊,袁宏声,唐红,等.二尖瓣置换术后三尖瓣反流的逆转、残留或加重.中国胸心血管外科临床杂志,2006,13 (5):307-310.
2. Ruel M,Rubens FD,Masters RG,et al.Late incidence and predictors of persistent or recurrent heart failure in patients with mitral prosthetic valves.J Thorac Cardiovasc Surg,2004,128 (2):278-283.
3. Kwak JJ,Kim YJ,Kim MK,et al.Development of tricuspid regurgitation late after left-sided valve surgery:a single-center experience with long-term echocardiographic examinations.Am Heart J,2008,155 (4):732-737.
4. Matsuyama K,Matsumoto M,Sugita T,et al.Predictors of residual tricuspid regurgitation after mitral valve surgery.Ann Thorac Surg,2003,75 (6):1826-1828.
5. Izumi C,Miyake M,Takahashi S,et al.Progression of isolated tricuspid regurgitation late after left-sided valve surgery.Clinical features and mechanisms.Circ J,2011,75 (12):2902-2907.
6. Matsunaga A,Duran CM.Progression of tricuspid regurgitation after repaired functional ischemic mitral regurgitation.Circulation,2005,112 (9 Suppl):I453-I457.
7. Spinner EM,Lerakis S,Higginson J,et al.Correlates of tricuspid regurgitation as determined by 3D echocardiography:pulmonary arterial pressure,ventricle geometry,annular dilatation,and papillary muscle displacement.Circ Cardiovasc Imaging,2012,5 (1):43-50.
8. Benedetto U,Melina G,Angeloni E,et al.Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery.J Thorac Cardiovasc Surg,2012,143 (3):632-638.
9. Katsi V,Raftopoulos L,Aggeli C,et al.Tricuspid regurgitation after successful mitral valve surgery.Interact Cardiovasc Thorac Surg,2012,15 (1):102-108.
10. Spinner EM,Shannon P,Buice D,et al.In vitro characterization of the mechanisms responsible for functional tricuspid regurgitation.Circulation,2011,124 (8):920-929.
11. Vargas Abello LM,Klein AL,Marwick TH,et al.Understanding right ventricular dysfunction and functional tricuspid regurgitation accompanying mitral valve disease.J Thorac Cardiovasc Surg,2013,145 (5):1234-1241.
12. Seo HS,Ha JW,Moon JY,et al.Right ventricular remodeling and dysfunction with subsequent annular dilatation and tethering as a mechanism of isolated tricuspid regurgitation.Circ J,2008,72 (10):1645-1649.
13. Yoo JS,Kim JB,Jung SH,et al.Impact of the maze procedure and postoperative atrial fibrillation on progression of functional tricuspid regurgitation in patients undergoing degenerative mitral repair.Eur J Cardiothorac Surg,2013,43 (3):520-525.
14. Song H,Kim MJ,Chung CH,et al.Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery.Heart,2009,95 (11):931-936.
15. Je HG,Song H,Jung SH,et al.Impact of the maze operation on the progression of mild functional tricuspid regurgitation.J Thorac Cardiovasc Surg,2008,136 (5):1187-1192.
16. Stulak JM,Schaff HV,Dearani JA,et al.Restoration of sinus rhythm by the Maze procedure halts progression of tricuspid regurgitation after mitral surgery.Ann Thorac Surg,2008,86 (1):40-45.
17. Kim HK,Kim YJ,Kim KI,et al.Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time.Circulation,2005,112 (9 Suppl):I14-I19.
18. Pfannmüller B,Moz M,Misfeld M,et al.Isolated tricuspid valve surgery in patients with previous cardiac surgery.J Thorac Cardiovasc Surg,2013,146 (4):841-847.
19. Chen SW,Tsai FC,Tsai FC,et al.Surgical risk and outcome of repair versus replacement for late tricuspid regurgitation in redo operation.Ann Thorac Surg,2012,93 (3):770-775.
20. Park K,Kim HK,Kim YJ,et al.Incremental prognostic value of early ostoperative right ventricular systolic function in patients undergoing surgery for isolated severe tricuspid regurgitation.Heart,2011,97 (16):1319-1325.
21. Topilsky Y,Khanna AD,Oh JK,et al.Preoperative factors associated with adverse outcome after tricuspid valve replacement.Circulation,2011,123 (18):1929-1939.
22. Kim YJ,Kwon DA,Kim HK,et al.Determinants of surgical outcome in patients with isolated tricuspid regurgitation.Circulation,2009,120 (17):1672-1678.
23. Xiao XJ,Huang HL,Zhang JF,et al.Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement.Heart Lung Circ,2004,13 (1):65-69.
24. 肖学钧,何竞功,卢聪,等.左心瓣膜置换术后远期三尖瓣关闭不全的外科治疗.中国胸心血管外科临床杂志,2003,10 (4):298-299.
25. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC),European Association for Cardio-Thoracic Surgery (EACTS),Vahanian A,et al.Guidelines on the management of valvular heart disease (version 2012).Eur Heart J,2012,33 (19):2451-2496.
26. Nishimura RA,Carabello BA,Faxon DP,et al.Acc/aha 2008 guideline update on valvular heart disease:focused update on infective endocarditis:a report of the american college of cardiology/american heart association task force on practice guidelines:endorsed by the society of cardiovascular anesthesiologists,society for cardiovascular angiography and interventions,and society of thoracic surgeons.Circulation,2008,118 (8):887-896.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment for Isolated Tricuspid Regurgitation after Left-Sided Valve Replacement

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