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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Does moderate tricuspid regurgitation require attention during mitral valve surgery?
Alexander Yeates1, Thomas Marwick, Rajeev Deva
1Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
ANZ Journal of Surgery
|January 22, 2013
Summary
Tricuspid regurgitation (TR) ≥ 2+ did not benefit from tricuspid valve repair (TVR) during mitral valve surgery. Patients not undergoing TVR showed better functional class and survival, with similar quality of life.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Tricuspid regurgitation (TR) is a common finding during mitral valve surgery.
- The necessity of addressing moderate (≥2+) TR during these procedures remains debated.
- This study investigates the impact of TR severity on outcomes after isolated mitral valve surgery.
Purpose of the Study:
- To evaluate whether moderate or severe tricuspid regurgitation (TR ≥ 2+) requires intervention during mitral valve surgery.
- To compare outcomes between patients undergoing mitral valve surgery with and without tricuspid valve repair (TVR).
Main Methods:
- A cohort of 161 patients undergoing primary, isolated mitral valve procedures between 1999 and 2009 were analyzed.
- Preoperative echocardiography assessed TR severity, right ventricular function, and pressures.
- Tricuspid valve repair (ring annuloplasty) was performed in 22 of 56 patients with TR ≥ 2+.
Main Results:
- Patients with moderate TR (≥2+) had worse baseline functional class and higher operative risks.
- Univariate and adjusted analyses showed poorer preoperative TR was associated with worse survival.
- Despite TVR in some cases, the TVR group had significantly lower 5-year survival (42%) compared to the non-TVR group (90%).
- Functional class improvement was better in the non-TVR group post-operatively.
- Quality of life indices were comparable between groups regardless of TR severity or TVR status.
Conclusions:
- Preoperative moderate to severe tricuspid regurgitation (TR ≥ 2+) does not necessitate tricuspid valve repair during isolated mitral valve surgery.
- The non-TVR group demonstrated more favorable functional class and mid-term survival.
- Comparable quality of life and echocardiographic parameters suggest TVR may not improve outcomes in this patient population.
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