Outcome of consistent guideline-based tricuspid management in patients undergoing degenerative mitral regurgitation correction

Dreyfus, Gilles D.; Essayagh, Benjamin; Benfari, Giovanni; Dulguerov, Filip; Haley, Shelley Rahman; Dommerc, Carine; Albert, Adelin; Enriquez-Sarano, Maurice

doi:10.1016/j.xjon.2021.07.010

Article (Scientific journals)

Outcome of consistent guideline-based tricuspid management in patients undergoing degenerative mitral regurgitation correction

Dreyfus, Gilles D.; Essayagh, Benjamin; Benfari, Giovanni et al.

2021 • In JTCVS Open

Peer reviewed

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https://hdl.handle.net/2268/266289

DOI
10.1016/j.xjon.2021.07.010

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Keywords :

tricuspid regurgitation; ACC/AHA guidelines; mitral valve repair; tricuspid annular diameter

Abstract :

[en] Objectives Despite coherent guidelines, management of functional tricuspid regurgitation (FTR) consequences on outcome in the context of degenerative mitral regurgitation (DMR) remains controversial due to lacking series of large magnitude with rigorous application of tricuspid guidelines and strict long-term echocardiographic follow-up. Thus, we aimed at gathering such a cohort to examine outcomes of patients undergoing DMR surgery following tricuspid surgery guidelines. Methods All consecutive patients with isolated DMR 2005-2015 operated on with baseline FTR assessment and tricuspid annulus diameter measurement were identified. Operative complications, postoperative tricuspid regurgitation incidence, and survival were assessed overall and stratified by guideline-based tricuspid annuloplasty (TA) indication (severe FTR or tricuspid annulus diameter ≥40 mm). Results 234, 53%) had generally similar presentation versus without TA (n = 207, 47%; all P ≥ .2) except for more atrial fibrillation and larger left ventricle (both P ≥ .0003). Patients with TA showed longer bypass time, more maze procedures (all P ≤ .001), but hospital stay, renal-failure, pacemaker implantation, and operative mortality (overall 0.9%) were comparable (all P ≥ .2). Postoperative incidence of moderate/severe FTR (0% at 1 year) became over time greater among patients without TA (5-year 8% [4%-13%] vs 3% [1%-11%] and 10-year 10% [6%-16%] vs 4% [1%-16%], P = .01). Survival (95% confidence interval) throughout follow-up was 85% (77%-89%) at 10 years, with hazard ratio 0.57 (0.29-1.10), P = .09. for patients with TA versus without. Conclusions In this large surgical DMR cohort, guideline-based FTR management was safe and effective. While long-term mortality did not reach significance, postoperative incidence of moderate/severe FTR, overall low, was nevertheless greater in patients who did not appear to require TA at surgery and linked to tricuspid annular dimension. Thus, future multicenter prospective cohorts with long-term follow-up are warranted to re-examine thresholds for TA performance and impact on survival.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

Dreyfus, Gilles D.

Essayagh, Benjamin

Benfari, Giovanni

Dulguerov, Filip

Haley, Shelley Rahman

Dommerc, Carine

Albert, Adelin ; Université de Liège - ULiège > Département des sciences de la santé publique > Département des sciences de la santé publique

Enriquez-Sarano, Maurice

Language :

English

Title :

Outcome of consistent guideline-based tricuspid management in patients undergoing degenerative mitral regurgitation correction

Publication date :

2021

Journal title :

JTCVS Open

eISSN :

2666-2736

Peer reviewed :

Peer reviewed

Additional URL :

https://www.sciencedirect.com/science/article/pii/S2666273621001959

Available on ORBi :

since 20 December 2021

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