Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation.
Publication/Presentation Date
2-16-2021
Abstract
BACKGROUND: Whether to repair nonsevere tricuspid regurgitation (TR) during surgery for ischemic mitral valve regurgitation (IMR) remains uncertain.
OBJECTIVES: The goal of this study was to investigate the incidence, predictors, and clinical significance of TR progression and presence of ≥moderate TR after IMR surgery.
METHODS: Patients (n = 492) with untreated nonsevere TR within 2 prospectively randomized IMR trials were included. Key outcomes were TR progression (either progression by ≥2 grades, surgery for TR, or severe TR at 2 years) and presence of ≥moderate TR at 2 years.
RESULTS: Patients' mean age was 66 ± 10 years (67% male), and TR distribution was 60% ≤trace, 31% mild, and 9% moderate. Among 2-year survivors, TR progression occurred in 20 (6%) of 325 patients. Baseline tricuspid annular diameter (TAD) was not predictive of TR progression. At 2 years, 37 (11%) of 323 patients had ≥moderate TR. Baseline TR grade, indexed TAD, and surgical ablation for atrial fibrillation were independent predictors of ≥moderate TR. However, TAD alone had poor discrimination (area under the curve, ≤0.65). Presence of ≥moderate TR at 2 years was higher in patients with MR recurrence (20% vs. 9%; p = 0.02) and a permanent pacemaker/defibrillator (19% vs. 9%; p = 0.01). Clinical event rates (composite of ≥1 New York Heart Association functional class increase, heart failure hospitalization, mitral valve surgery, and stroke) were higher in patients with TR progression (55% vs. 23%; p = 0.003) and ≥moderate TR at 2 years (38% vs. 22%; p = 0.04).
CONCLUSIONS: After IMR surgery, progression of unrepaired nonsevere TR is uncommon. Baseline TAD is not predictive of TR progression and is poorly discriminative of ≥moderate TR at 2 years. TR progression and presence of ≥moderate TR are associated with clinical events. (Comparing the Effectiveness of a Mitral Valve Repair Procedure in Combination With Coronary Artery Bypass Grafting [CABG] Versus CABG Alone in People With Moderate Ischemic Mitral Regurgitation, NCT00806988; Comparing the Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in People With Severe Chronic Ischemic Mitral Regurgitation, NCT00807040).
Volume
77
Issue
6
First Page
713
Last Page
724
ISSN
1558-3597
Published In/Presented At
Bertrand, P. B., Overbey, J. R., Zeng, X., Levine, R. A., Ailawadi, G., Acker, M. A., Smith, P. K., Thourani, V. H., Bagiella, E., Miller, M. A., Gupta, L., Mack, M. J., Gillinov, A. M., Giustino, G., Moskowitz, A. J., Gelijns, A. C., Bowdish, M. E., O'Gara, P. T., Gammie, J. S., Hung, J., … Cardiothoracic Surgical Trials Network (CTSN) (2021). Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation. Journal of the American College of Cardiology, 77(6), 713–724. https://doi.org/10.1016/j.jacc.2020.11.066
Disciplines
Medicine and Health Sciences
PubMedID
33573741
Department(s)
Department of Surgery
Document Type
Article