Should moderate tricuspid regurgitation be repaired at the time of mitral surgery? Results from a large registry-based study

IF 1.9
Ali Hage MD, MPH , Eugene H. Blackstone MD , Tarek Malas MD, MPH , Lars G. Svensson MD, PhD , Ashley M. Lowry MS, MEd , Annalisa Bernabei MD , Kenneth McCurry MD , Haytham Elgharably MD , Marc Gillinov MD
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Abstract

Objectives

To trace the temporal trajectory of unrepaired moderate tricuspid regurgitation (TR) after primary, isolated mitral valve repair (MVr) alone compared with none or mild TR, and to determine whether moderate TR is associated with worse survival.

Methods

Between January 1, 2000, and December 21, 2022, a total of 5467 consecutive patients (mean age, 58 ±12 years) with severe degenerative mitral regurgitation (MR) underwent MVr alone without concomitant TR repair. Of these, 3418 (63%) had no TR, 1652 (30%) had mild TR, and 397 (7%) had moderate TR. They were followed prospectively for a maximum duration of 24 years.

Results

Patients with preoperative moderate TR had an increased unadjusted risk of mortality (70% survival) at 14 years compared to patients with mild TR (81% survival) and those with no TR (85% survival), mostly related to a higher baseline risk profile. Patients who died during follow-up were more likely to have moderate TR compared to those who survived. Among patients with unaddressed moderate preoperative TR, the proportion with persistent moderate TR dropped to 19% (from 100%) immediately after MVr and then increased to 31% at 10 years. Degree of preoperative TR and postoperative MR were associated with moderate or greater TR during follow-up.

Conclusions

Patients with untreated preoperative moderate TR undergoing isolated MV surgery had incomplete resolution of their TR. The presence of moderate TR during follow-up was associated with increased mortality at long-term follow-up, mostly related to a higher baseline risk profile. MR perhaps should be treated before the development of moderate TR.
中度三尖瓣反流应在二尖瓣手术时修复吗?来自一项大型注册研究的结果
目的探讨单纯单纯二尖瓣修复(MVr)术后未修复中度三尖瓣返流(TR)与未修复或轻度二尖瓣返流的时间轨迹,并确定中度三尖瓣返流是否与较差的生存率相关。方法:2000年1月1日至2022年12月21日,共有5467例严重退行性二尖瓣反流(MR)患者(平均年龄58±12岁)连续行MVr,未合并TR修复。其中,3418例(63%)无TR, 1652例(30%)有轻度TR, 397例(7%)有中度TR。这些患者的最长随访时间为24年。与轻度TR(81%生存率)和无TR(85%生存率)患者相比,术前中度TR患者在14年时的未调整死亡率(70%生存率)增加,主要与较高的基线风险相关。在随访期间死亡的患者比存活的患者更有可能患有中度TR。在术前未解决的中度TR患者中,MVr后立即持续中度TR的比例下降到19%(从100%),然后在10年时增加到31%。术前TR和术后MR的程度与随访中中度或较大的TR相关。结论术前未经治疗的中度TR患者接受孤立MV手术,其TR不完全消退。随访期间中度TR的存在与长期随访死亡率增加相关,主要与较高的基线风险相关。MR可能应该在发展为中度TR之前进行治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
1.70
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