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Functional tricuspid insufficiency: conservative or operative management.

W Klepetko, M Klicpera, G Kronik

    The Thoracic and Cardiovascular Surgeon
    |June 1, 1985
    PubMed
    Summary

    Surgical treatment of tricuspid valve regurgitation (TI) during mitral valve replacement is more effective than conservative management. Recurrence of functional TI depends on the treatment method, not preoperative hemodynamics.

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    Area of Science:

    • Cardiology
    • Cardiac Surgery
    • Cardiovascular Medicine

    Background:

    • Mitral valve disease often coexists with functional tricuspid insufficiency (TI).
    • Effective management of TI during mitral valve replacement (MVR) is crucial for patient outcomes.
    • Previous studies have not clearly established the optimal treatment strategy for concomitant TI during MVR.

    Purpose of the Study:

    • To evaluate the efficacy of different surgical and conservative treatments for functional tricuspid insufficiency (TI) in patients undergoing mitral valve replacement (MVR).
    • To determine if preoperative hemodynamic parameters influence the recurrence of TI after MVR.

    Main Methods:

    • Retrospective analysis of 43 patients with mitral valve disease and functional TI undergoing MVR between 1978 and 1982.

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  • Patients were treated with either conservative management (17), Carpentier ring annuloplasty (9), De Vega annuloplasty (13), or Hancock bioprosthesis (4).
  • Clinical and echocardiographical follow-up was performed, with hemodynamic assessment including pulmonary vascular resistance (PVR), pulmonary artery pressure (PAP), and right atrial V-wave.

    • Main Results:

    • Hospital mortality was high (26%) due to patients' poor clinical condition.
    • After a mean follow-up of 43.1 months, all conservatively treated patients had recurrent TI.
    • Surgical interventions showed better results, with 7/11 patients having no TI, 3 mild TI, and 1 severe TI.
    • No significant differences in preoperative PVR, PAP, or V-wave were found between groups with or without recurrent TI at follow-up.

    Conclusions:

    • Surgical repair or replacement of the tricuspid valve is superior to conservative management for functional TI in patients undergoing MVR.
    • The recurrence of functional TI is primarily determined by the chosen treatment method, not by preoperative hemodynamic status.
    • These findings underscore the importance of addressing TI surgically during MVR to prevent recurrence.