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Should Moderate Functional Tricuspid Regurgitation Be Repaired During Surgery for Rheumatic Mitral Valve Disease?
Hosam F Fawzy1, Ahmed A Morsy1, Amro R Serag1
1Department of Cardio-Thoracic Surgery, Tanta University, Tanta, Egypt.
Heart, Lung & Circulation
|March 23, 2020
Summary
Concomitant tricuspid valve repair during mitral valve surgery for rheumatic disease is safe and beneficial. It reduces rehospitalization for heart failure and the need for future tricuspid valve interventions.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Rheumatic Heart Disease
Background:
- Surgical repair of moderate tricuspid regurgitation (TR) during mitral valve (MV) surgery is debated.
- Rheumatic MV disease often presents with concomitant TR.
Purpose of the Study:
- To evaluate outcomes of concomitant tricuspid valve (TV) repair in patients with rheumatic MV disease and moderate functional TR.
- Compare outcomes between MV surgery with TV repair versus MV surgery alone.
Main Methods:
- Retrospective analysis of 1,240 patients with rheumatic MV disease and moderate TR (1998-2016).
- 974 patients underwent MV surgery with TV repair (Group 1), 266 had MV surgery alone (Group 2).
- Propensity score matching created 192 pairs for outcome comparison: operative outcomes, rehospitalisation for congestive heart failure (CHF), and TV reintervention.
Main Results:
- Concomitant TV repair patients were younger and had fewer diabetics.
- Matched analysis showed no difference in operative times or ICU stay.
- Group 2 (MV surgery alone) had higher rates of low cardiac output, TV reintervention, and CHF rehospitalisation.
Conclusions:
- Concomitant TV repair for moderate TR in rheumatic MV surgery does not increase operative risk.
- TV repair is associated with lower rates of postoperative low cardiac output syndrome, late TV reinterventions, and CHF rehospitalisation.
- Concomitant TV repair may be beneficial for selected patients undergoing rheumatic MV surgery.
Keywords:
Functional tricuspid regurgitationModerate tricuspid regurgitationRheumatic mitral valve diseaseTricuspid valve repairMore Related Videos
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