Tricuspid annular dynamics, not diameter, predicts tricuspid regurgitation after mitral valve surgery: Results from a prospective randomized trialCentral MessagePerspective
Matteo Pettinari, MD,
Laurent De Kerchove, MD, PhD,
Michel Van Dyck, PhD,
Agnes Pasquet, MD, PhD,
Bernhard Gerber, MD, PhD,
Gebrine El-Khoury, MD,
Jean-Louis Vanoverschelde, MD, PhD
Affiliations
Matteo Pettinari, MD
Cardiac Surgery Department, Ziekenhuis Oost Limburg, Genk, Belgium; Address for reprints: Matteo Pettinari, MD, Cardiac Surgery Department, Ziekenhuis Oost Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
Laurent De Kerchove, MD, PhD
Division of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Universitè Catholique de Louvain, Brussels, Belgium
Michel Van Dyck, PhD
Division of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
Agnes Pasquet, MD, PhD
Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Universitè Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
Bernhard Gerber, MD, PhD
Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Universitè Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
Gebrine El-Khoury, MD
Division of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Universitè Catholique de Louvain, Brussels, Belgium
Jean-Louis Vanoverschelde, MD, PhD
Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Universitè Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
Objective: Current guidelines advise using prophylactic tricuspid valve annuloplasty during mitral valve surgery, especially in the presence of annular diameter enlargement. However, several retrospective studies and a prospective randomized study from our department could not confirm that diameter enlargement is predictive of late regurgitation. We examined whether 2- and 3-dimensional echocardiographic and clinical characteristics could identify patients who will develop moderate or severe recurrent tricuspid regurgitation. Methods: Patients with less than severe functional tricuspid regurgitation (FTR) were randomized not to receive tricuspid annuloplasty, and 11 of 53 of them were excluded from the study because 3-dimensional echocardiographic analysis was not possible. Cox regression was used to estimate the model-based probability of moderate or severe FTR (vena contracta ≥3 mm) or progression of TR and FTR regression using valve dimensions (annulus area, diameter perimeter, nonplanar angle, and sphericity index), dynamics (annulus contraction, annulus displacement, and displacement velocity), and clinical parameters as possible predictors. Results: At a median follow-up of 3.8 years (range, 3-5.6 years), 17 patients had moderate or severe FTR or progression, and 13 had FTR regression. Our models identified annular displacement velocity as a significant predictor for FTR recurrence and nonplanar angle as a significant predictor for FTR regression. Conclusions: Annular dynamics, not the dimension, predict recurrence and regression of FTR. Annular contraction should be systematically investigated as a possible surrogate of right ventricle function to prophylactically treat the tricuspid valve.
