Surgical management of tricuspid regurgitation: a new algorithm to minimise recurrent tricuspid regurgitation
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Rodríguez Torres, Diego; Torres Quintero, Lucía; Segura Rodríguez, Diego; Garrido Jiménez, José Manuel; Esteban Molina, María; Gomera Martínez, Francisco; Moreno Escobar, Eduardo; García Orta, RocíoEditorial
BMJ
Date
2022-07-25Referencia bibliográfica
Rodriguez Torres D... [et al.]. Surgical management of tricuspid regurgitation: a new algorithm to minimise recurrent tricuspid regurgitation. Open Heart 2022;9:e002011. doi:[10.1136/openhrt-2022-002011]
Abstract
Introduction Recurrent tricuspid regurgitation (TR) is
frequently observed after cardiac surgery; however, the
correct approach remains controversial. We developed an
algorithm for action on the tricuspid valve (TV) and conducted
a 1-year
follow-up
study. The aim was to assess the efficacy
of the algorithm to minimise residual TR after TV surgery. The
hypothesis was that the TR rate at 1 year would be reduced
by selecting the surgical approach in accordance with a set of
preoperative clinical and echocardiographic variables.
Methods A prospective, observational, single-centre
study was performed in 76 consecutive patients with TV
involvement. A protocol was designed for their inclusion, and
data on their clinical and echocardiographic characteristics
were gathered at 3 months and 1-year
postsurgery. The
treatment of patients depended on the degree of TR. Surgery
was performed in all patients with severe or moderate-to-
severe
TR and in those with mild or moderate TR alongside
the presence of certain clinical or echocardiographic factors.
They underwent annuloplasty or extended valve repair when
the TV was distorted. If repair techniques were not feasible, a
prosthesis was implanted. Residual TR rates were compared
with published reports, and predictors of early/late mortality
and residual TR were evaluated.
Results TR was functional in 69.9% of patients. Rigid
ring annuloplasty was performed in 35.7% of patients, De
Vega annuloplasty in 27.1%, extended repair in 11.4%
and prosthetic replacement in 25.7%. TR was moderate
or worse in 8.19% of patients (severe in 3.27%) at 1 year
postintervention. No clinical, surgical or epidemiological
variables were significantly associated with residual TR
persistence, although annulus diameter showed a close-to-
significant
association. Total mortality was 12.85%
for all causes and 10% for cardiovascular causes. In
multivariate analysis, left ventricular ejection fraction was
related to both early and late mortality.
Conclusions Severe residual TR was significantly less
frequent than reported in other series, being observed in
less than 4% of patients at 1-year
postsurgery.