Long-term Outcomes of Prophylactic Tricuspid Annuloplasty in Patients Undergoing Mitral Valve Surgery

#AC/VAL 01-EP-10
Adult Cardiac Surgery/Valves. E-POSTER (ORAL) SESSION 1
E-Poster (oral)

Long-term Outcomes of Prophylactic Tricuspid Annuloplasty in Patients Undergoing Mitral Valve Surgery

Takano Hiroshi¹, Takashi Yamauchi¹, Shigeyoshi Gon¹, Masahito Saito¹, Naoki Asano¹, Kazunori Ota¹, Kazuho Niimi¹, Keiwa Kin², Yukitoshi Shirakawa²

¹Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan; ²Osaka General Medical Center, Osaka, Japan;

Date, time and location: 2018.05.25 10:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective: Because tricuspid regurgitation (TR) usually does not disappear but often progresses after mitral valve surgery, we have aggressively performed tricuspid annuloplasty (TAP) using a prosthetic ring even in patients without severe TR at the time of mitral valve surgery. We investigated the risk factors for postoperative TR in patients who underwent prophylactic TAP.

Methods: We retrospectively studied 123 patients who underwent concomitant TAP for less-than-severe TR at the time of mitral valve surgery from 1998 to 2012. The etiology of mitral valve disease was degenerative in 47, rheumatic in 43, ischemic in 13, infectious endocarditis in 10, and others in 10. The mitral valve was replaced in 64 patients and repaired in 59. The grade of preoperative TR was moderate in 41, mild in 79, and trivial or none in 3 patients. The preoperative tricuspid annular diameter (TAD) was 24.0 ± 2.7 mm/m². The implanted prosthetic ring was flexible (Cosgrove^®, Duran^®, or Tailor^®) in 81 patients and rigid (MC^3®) in 42. The rate of freedom from TR and the risk factors for late TR were statistically analyzed.

Results: The mean follow-up period was 7.7 years (range, 1.0–19.0 years). The 10-year rate of freedom from severe TR was 100%, and the 5- and 10-year rates of freedom from moderate TR were 92% and 85%, respectively. Risk factors for moderate postoperative TR were preoperative pulmonary hypertension (hazard ratio, 6.12; P = 0.007) and older age (≥60 years) (hazard ratio, 18.1; P = 0.02). The grade of preoperative TR, preoperative TAD, and type and size of the prosthetic ring were not risk factors.

Conclusions: Prophylactic TAP for less-than-severe TR in patients undergoing mitral valve surgery may not completely prevent moderate postoperative TR, and risk factors include pulmonary hypertension and older age. Some additional refinement might be necessary for these patients.