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Late Results Of Patients Undergoing Tricuspid Ring Annuloplasty For Functional Tricuspid Regurgitation In Mitral Valve Surgery
Naoto Fukunaga, Yukikatsu Okada, Yoshito Sakon, Yasunobu Konishi, Ken Nakamura, Takashi Murashita, Hideo Kanemitsu, Tadaaki Koyama.
Kobe City Medical Center General Hospital, Kobe, Japan.

OBJECTIVE: We reviewed 10-year experience to assess late survival and recurrence or progression of functional tricuspid regurgitation (TR) after tricuspid ring annuloplasty (TAP) for functional TR in the setting of mitral valve surgery.
METHODS: We retrospectively analyzed 220 patients who underwent TAP for functional TR concomitant with mitral valve repair (MVP; n = 160) or replacement (MVR; n = 60) as an initial surgery from January 2000 to December 2010. Most frequent pathology in MVP was degenerative and in MVR was rheumatic mitral valve disease. The mean age was 65.4±11.4 years and 107 male patients (48.6%) were included. Sixty-one patients (27.7%) were at New York Heart Association functional class III or IV (MVP; 57.3%, MVR; 42.7%). One-hundred and forty-seven patients (66.8%) had preoperative atrial fibrillation (MVP; 58.8%, MVR; 41.2%). Preoperative degree of functional TR and right ventricular pressure were 1.9±0.9 and 46.6±14.0 mmHg, respectively. Left ventricular ejection fraction rate was 62.3±10.5%. Indications of TAP at the time of mitral valve surgery included functional TR more than mild, a history of right heart failure, new onset of atrial fibrillation or pulmonary hypertension. The flexible ring or band was used for TAP. Mean follow-up period was 4.4±2.6 years.
RESULTS: Hospital mortality rate was 5.5% (12/220). The size of flexible ring or band were 27mm or 29mm in most cases. Pre-discharge degree of TR was 0.7±0.6 and TR of mild or less was identified in 04 patients (93%). Overall survival at 5 and 10 years were 90.2%±2.1% and 82.4%±5.6%, respectively. Late recurrent TR was defined as an increase in TR by greater than one grade and a final TR grade of more than mild. Freedom from late recurrent TR at 5 and 8 years were 87.7%±4.2% and 78.0%±6.6%, respectively. A Predictor of late recurrent TR was elevated right ventricular pressure at final follow-up (HR, 1.091; p = 0.0003). Degree of TR at final follow-up was 0.9±0.7.
CONCLUSIONS: Late outcomes of patients who underwent TAP based on our strategy were acceptable. Late recurrent TR was associated with irreversible elevated right ventricular pressure.

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