Author + information
- Leslie Parikh,
- Athena Poppas,
- Saddam Abisse,
- Patrick Gleason,
- Andrew Maslow,
- Arun Singh and
- Lindsey Cilia
Background: Secondary or functional tricuspid regurgitation (TR) typically occurs as a result of left-sided heart or pulmonary disease. Selection of the appropriate tricuspid valve procedure for patients with FTR remains a challenging clinical question. The failure rate for tricuspid ring annuloplasty in patients with TR undergoing concomitant mitral valve surgery remains high and can lead to significant morbidity and mortality. The aim of our study is to identify echocardiographic predictors of recurrent moderate to severe tricuspid regurgitation after tricuspid ring annuloplasty.
Methods and Results: We conducted a single center, retrospective analysis of patients who have undergone mitral valve repair with concomitant tricuspid ring annuloplasty between 1996-2011. Preoperative echocardiographic measurements using the apical four chamber view included: tricuspid valve annulus end-diastolic diameter (TVADd), tricuspid valve length and tenting height, basal right ventricular end-diastolic dimension (RVEDD) and qualitative right and left ventricular function. Tricuspid repair failure was defined as the presence of grade 3-4+ TR on follow up echocardiogram. Significant tricuspid regurgitation was defined as the presence of grade 2+. 114 patients met our search criteria and 60 had adequate follow-up data (Mean age 71± 13, Female 70%, LVEF 53 ± 11%, time to follow up echocardiogram mean 13.6± 16.7 months). Patients with grade 3-4+ TR (n=10) on follow up echocardiogram compared to those with grade 1-2 TR (n=50) had a larger pre-operative TVADd 42.5mm (95% CI 37.5-47.5) vs 36.8mm (95% CI 35.2-38.5), p<0.001), TVADs (36.6 vs 32.2, p < 0.04) and RVEDD (47.3 vs 43.3mm, p=0.073). On a multivariate predictive model analysis, TVADd was an independent predictor of tricuspid ring repair failure (OR 1.54, 95% CI 1.07-2.2, p<0.02).
Conclusions: Tricuspid annular dilatation on preoperative 2D echocardiography is predictive of subsequent tricuspid ring annuloplasty failure. In these patients, further investigation into leaflet morphology is warranted to better determine the choice of tricuspid surgery procedure at the time of mitral valve surgery.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 10:15 a.m.-10:25 a.m.
Session Title: Tricuspid Regurgitation: Signals in Plain Sight
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 1303M-07
- 2017 American College of Cardiology Foundation