"prophylactic" tricuspid repair for functional tricuspid regurgitation

Nicholas R. Teman, Lynn C. Huffman, Marguerite Krajacic, Francis D. Pagani, Jonathan W. Haft, Steven F. Bolling

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background The optimal management of functional tricuspid regurgitation (FTR) in the setting of mitral valve operations remains controversial. The objective of this study is to compare the outcomes of congestive heart failure patients who underwent a prophylactic tricuspid operation for FTR as a component of their initial mitral valve procedure with those who underwent a redo tricuspid operation at a later date for residual FTR. Methods Patients with FTR repaired as a redo operation between 2004 and 2012 were identified. These patients were propensity-matched 1:2 with contemporaneous patients with FTR or tricuspid dilatation who underwent tricuspid repair at the same time as mitral valve repair. Demographic information, postoperative complications, and short-term and long-term mortality rates were compared between groups. Results There were 21 patients treated with redo tricuspid valve repair matched with 42 patients treated prophylactically. There were 3 deaths at 30 days in the redo group (14%), compared with zero in the prophylactic group (p = 0.03). Overall long-term mortality in the redo group was 29% (6 of 21), with a mean 31 months of follow-up, but was only 14% (6 of 42) in the prophylactic group, with a mean 25 months of follow-up. Kaplan-Meier long-term survival analysis did not reveal a difference between groups (log-rank p = 0.37) once the perioperative period was survived. Conclusions Redo tricuspid valve repair for residual FTR can be performed with acceptable short-term and long-term mortality. However, treatment of FTR at the time of the initial intervention should be considered, because it is safe and effective. A randomized, controlled trial of prophylactic tricuspid operation for FTR at the time of the mitral operation may be warranted.

Original languageEnglish (US)
Pages (from-to)1520-1524
Number of pages5
JournalAnnals of Thoracic Surgery
Volume97
Issue number5
DOIs
StatePublished - 2014

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Tricuspid Valve Insufficiency
Mitral Valve
Tricuspid Valve
Mortality
Perioperative Period
Survival Analysis
Dilatation
Randomized Controlled Trials
Heart Failure
Demography

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

"prophylactic" tricuspid repair for functional tricuspid regurgitation. / Teman, Nicholas R.; Huffman, Lynn C.; Krajacic, Marguerite; Pagani, Francis D.; Haft, Jonathan W.; Bolling, Steven F.

In: Annals of Thoracic Surgery, Vol. 97, No. 5, 2014, p. 1520-1524.

Research output: Contribution to journalArticle

Teman, Nicholas R. ; Huffman, Lynn C. ; Krajacic, Marguerite ; Pagani, Francis D. ; Haft, Jonathan W. ; Bolling, Steven F. / "prophylactic" tricuspid repair for functional tricuspid regurgitation. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 5. pp. 1520-1524.
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abstract = "Background The optimal management of functional tricuspid regurgitation (FTR) in the setting of mitral valve operations remains controversial. The objective of this study is to compare the outcomes of congestive heart failure patients who underwent a prophylactic tricuspid operation for FTR as a component of their initial mitral valve procedure with those who underwent a redo tricuspid operation at a later date for residual FTR. Methods Patients with FTR repaired as a redo operation between 2004 and 2012 were identified. These patients were propensity-matched 1:2 with contemporaneous patients with FTR or tricuspid dilatation who underwent tricuspid repair at the same time as mitral valve repair. Demographic information, postoperative complications, and short-term and long-term mortality rates were compared between groups. Results There were 21 patients treated with redo tricuspid valve repair matched with 42 patients treated prophylactically. There were 3 deaths at 30 days in the redo group (14{\%}), compared with zero in the prophylactic group (p = 0.03). Overall long-term mortality in the redo group was 29{\%} (6 of 21), with a mean 31 months of follow-up, but was only 14{\%} (6 of 42) in the prophylactic group, with a mean 25 months of follow-up. Kaplan-Meier long-term survival analysis did not reveal a difference between groups (log-rank p = 0.37) once the perioperative period was survived. Conclusions Redo tricuspid valve repair for residual FTR can be performed with acceptable short-term and long-term mortality. However, treatment of FTR at the time of the initial intervention should be considered, because it is safe and effective. A randomized, controlled trial of prophylactic tricuspid operation for FTR at the time of the mitral operation may be warranted.",
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AU - Haft, Jonathan W.

AU - Bolling, Steven F.

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N2 - Background The optimal management of functional tricuspid regurgitation (FTR) in the setting of mitral valve operations remains controversial. The objective of this study is to compare the outcomes of congestive heart failure patients who underwent a prophylactic tricuspid operation for FTR as a component of their initial mitral valve procedure with those who underwent a redo tricuspid operation at a later date for residual FTR. Methods Patients with FTR repaired as a redo operation between 2004 and 2012 were identified. These patients were propensity-matched 1:2 with contemporaneous patients with FTR or tricuspid dilatation who underwent tricuspid repair at the same time as mitral valve repair. Demographic information, postoperative complications, and short-term and long-term mortality rates were compared between groups. Results There were 21 patients treated with redo tricuspid valve repair matched with 42 patients treated prophylactically. There were 3 deaths at 30 days in the redo group (14%), compared with zero in the prophylactic group (p = 0.03). Overall long-term mortality in the redo group was 29% (6 of 21), with a mean 31 months of follow-up, but was only 14% (6 of 42) in the prophylactic group, with a mean 25 months of follow-up. Kaplan-Meier long-term survival analysis did not reveal a difference between groups (log-rank p = 0.37) once the perioperative period was survived. Conclusions Redo tricuspid valve repair for residual FTR can be performed with acceptable short-term and long-term mortality. However, treatment of FTR at the time of the initial intervention should be considered, because it is safe and effective. A randomized, controlled trial of prophylactic tricuspid operation for FTR at the time of the mitral operation may be warranted.

AB - Background The optimal management of functional tricuspid regurgitation (FTR) in the setting of mitral valve operations remains controversial. The objective of this study is to compare the outcomes of congestive heart failure patients who underwent a prophylactic tricuspid operation for FTR as a component of their initial mitral valve procedure with those who underwent a redo tricuspid operation at a later date for residual FTR. Methods Patients with FTR repaired as a redo operation between 2004 and 2012 were identified. These patients were propensity-matched 1:2 with contemporaneous patients with FTR or tricuspid dilatation who underwent tricuspid repair at the same time as mitral valve repair. Demographic information, postoperative complications, and short-term and long-term mortality rates were compared between groups. Results There were 21 patients treated with redo tricuspid valve repair matched with 42 patients treated prophylactically. There were 3 deaths at 30 days in the redo group (14%), compared with zero in the prophylactic group (p = 0.03). Overall long-term mortality in the redo group was 29% (6 of 21), with a mean 31 months of follow-up, but was only 14% (6 of 42) in the prophylactic group, with a mean 25 months of follow-up. Kaplan-Meier long-term survival analysis did not reveal a difference between groups (log-rank p = 0.37) once the perioperative period was survived. Conclusions Redo tricuspid valve repair for residual FTR can be performed with acceptable short-term and long-term mortality. However, treatment of FTR at the time of the initial intervention should be considered, because it is safe and effective. A randomized, controlled trial of prophylactic tricuspid operation for FTR at the time of the mitral operation may be warranted.

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