Skip to main content
SpringerLink
Log in

Predictors of late outcomes after concomitant tricuspid valve repair with left-sided valve surgery

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

Concomitant tricuspid valve (TV) repair is a safe and effective procedure to protect against late moderate or greater tricuspid regurgitation (TR) after left-sided valve surgery, but studies regarding its late outcomes and recurrent TR are limited. This study aimed to reveal the late outcomes and explore the predictors of mortality and recurrent TR among patients who underwent concomitant TV repair with left-sided valve surgery.

Methods and results

This study included 645 patients (mean age, 69.7 years; 44% male) who underwent concomitant TV repair with left-sided valve surgery (mitral valve surgery in 594 cases, aortic valve surgery in 172 cases) from 2006–2020. Preoperative TR was grade 4, 3, and less than 2 in 85, 235, and 325 patients, respectively. The median follow-up period was 4.6 (IQR 1.7–7.8) years. The in-hospital or 30-day mortality was 1.7% (n = 11). Regarding long-term outcomes after TV repair, 90.3% and 80.8% achieved 5- and 10-year survival, respectively, while 96.1% and 88.8% achieved 5- and 10-year freedom from recurrent TR, respectively. The following were independent predictors of overall mortality on multivariate analysis in patients with preoperative TR grade ≥ 3: prior pacemaker implantation, preoperative renal dysfunction, diabetes mellitus and NYHA class ≥ 3. Also, suture annuloplasty and ring type of ring annuloplasty were not independent risk factors for recurrent TR, classified as grade ≥ 3.

Conclusions

Concomitant TV repair with left-sided valve surgery had acceptable outcomes in terms of survival and TR durability. In patients with preoperative TR grade ≥ 3, preoperative patient status had negative impacts on prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets generated and/ or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Kwak JJ, Kim YJ, Kim MK, Kim HK, Park JS, Kim KH, et al. Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations. Am Heart J. 2008;155:732–7.

    Article  PubMed  Google Scholar 

  2. Izumi C, Miyake M, Takahashi S, Matsutani H, Hashiwada S, Kuwano K, et al. Progression of isolated tricuspid regurgitation late after left-sided valve surgery: clinical features and mechanisms. Circ J. 2011;75:2902–7.

    Article  PubMed  Google Scholar 

  3. Lee H, Sung K, Kim WS, Lee YT, Park SJ, Carriere KC, et al. Clinical and hemodynamic influences of prophylactic tricuspid annuloplasty in mechanical mitral valve replacement. J Thorac Cardiovasc Surg. 2016;151:788–95.

    Article  PubMed  Google Scholar 

  4. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation 2021. 2020;143:e72–227.

    Google Scholar 

  5. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease: developed by the task force for the management of valvular heart disease of the European society of cardiology (ESC) and the European association for cardio-thoracic surgery (EACTS). Eur J Cardio Thorac Surg. 2021;60:727–800.

    Article  Google Scholar 

  6. Jeganathan R, Armstrong S, Al-Alao B, David T. The risk and outcomes of reoperative tricuspid valve surgery. Ann Thorac Surg. 2013;95:119–24.

    Article  PubMed  Google Scholar 

  7. Fujita T, Kobayashi J, Toda K, Nakajima H, Iba Y, Shimahara Y, et al. Long-term outcome of combined valve repair and maze procedure for nonrheumatic mitral regurgitation. J Thorac Cardiovasc Surg. 2010;140:1332–7.

    Article  PubMed  Google Scholar 

  8. Kakuta T, Fukushima S, Minami K, Saito T, Kawamoto N, Tadokoro N, et al. Novel risk score for predictiong recurrence of atrial fibrillation after the cryo-maze procedure. Eur J Cardiothorac Surg. 2021;59:1218–25.

    Article  PubMed  Google Scholar 

  9. Iqbal S, Chen PH. Passive liver congestion and hypoxic hepatitis. In: Cardio-hepatology: connections between hepatic and cardiovascular disease. Elsevier; 2023. p. 123–32.

    Chapter  Google Scholar 

  10. Parolari A, Barili F, Pilozzi A, Pacini D. Ring or suture annuloplasty for tricuspid regurgitation? A meta-analysis review. Ann Thorac Surg. 2014;98:2255–63.

    Article  PubMed  Google Scholar 

  11. Saran N, Dearani JA, Said SM, Greason KL, Pochettino A, Stulak JM, et al. Long-term outcomes of patients undergoing tricuspid valve surgery. Eur J Cardio Thorac Surg. 2019;56:950–8.

    Article  Google Scholar 

  12. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004;43:405–9.

    Article  PubMed  Google Scholar 

  13. Behm CZ, Nath J, Foster E. Clinical correlates and mortality of hemodynamically significant tricuspid regurgitation. J Heart Valve Dis. 2004;13:784–9.

    PubMed  Google Scholar 

  14. Amano M, Izumi C, Taniguchi T, Morimoto T, Miyake M, Nishimura S, et al. Impact of concomitant tricuspid regurgitation on long-term outcomes in severe aortic stenosis. Eur Heart J Cardiovasc Imaging. 2019;20:353–60.

    Article  PubMed  Google Scholar 

  15. Groves PH, Lewis NP, Ikram S, Maire R, Hall RJ. Reduced exercise capacity in patients with tricuspid regurgitation after successful mitral valve replacement for rheumatic mitral valve disease. Heart. 1991;66:295–301.

    Article  CAS  Google Scholar 

  16. Dreyfus J, Ghalem N, Garbarz E, Cimadevilla C, Nataf P, Vahanian A, et al. Timing of referral of patients with severe isolated tricuspid valve regurgitation to surgeons (from a French nationwide database). Am J Cardiol. 2018;122:323–6.

    Article  PubMed  Google Scholar 

  17. Antunes MJ, Rodríguez-Palomares J, Prendergast B, De Bonis M, Rosenhek R, Al-Attar N, et al. Management of tricuspid valve regurgitation. Eur J Cardio Thorac Surg. 2017;52:1022–30.

    Article  Google Scholar 

  18. Hung J, Koelling T, Semigran MJ, Dec GW, Levine RA, Di Salvo TG. Usefulness of echocardiographic determined tricuspid regurgitation in predicting event-free survival in severe heart failure secondary to idiopathic-dilated cardiomyopathy or to ischemic cardiomyopathy. Am J Cardiol. 1998;82:1301–3.

    Article  CAS  PubMed  Google Scholar 

  19. Izumi C. Isolated functional tricuspid regurgitation: when should we go to surgical treatment? J Cardiol. 2020;75:339–43.

    Article  PubMed  Google Scholar 

  20. Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Clinical and echocardiographic outcomes after surgery for severe isolated tricuspid regurgitation. J Thorac Cardiovasc Surg. 2013;146:278–84.

    Article  PubMed  Google Scholar 

  21. Dreyfus J, Audureau E, Bohbot Y, Coisne A, Lavie-Badie Y, Bouchery M, et al. TRI-SCORE: a new risk score for in-hospital mortality prediction after isolated tricuspid valve surgery. Eur Heart J. 2022;43:654–62.

    Article  CAS  PubMed  Google Scholar 

  22. Butcher SC, Fortuni F, Dietz MF, Prihadi EA, van der Bijl P, Ajmone Marsan N, et al. Renal function in patients with significant tricuspid regurgitation: pathophysiological mechanisms and prognostic implications. J Intern Med. 2021;290:715–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Rangaswami J, Bhalla V, Blair JEA, Chang TI, Costa S, Lentine KL, et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American heart association. Circulation. 2019;139:e840-878.

    Article  PubMed  Google Scholar 

  24. Ter Maaten JM, Damman K, Verhaar MC, Paulus WJ, Duncker DJ, Cheng C, et al. Connecting heart failure with preserved ejection fraction and renal dysfunction: the role of endothelial dysfunction and inflammation. Eur J Heart Fail. 2016;18:588–98.

    Article  PubMed  Google Scholar 

  25. Hata H, Fujita T, Miura S, Shimahara Y, Kume Y, Matsumoto Y, et al. Long-term outcomes of suture vs. ring tricuspid annuloplasty for functional tricuspid regurgitation. Circ J. 2017;81:1432–8.

    Article  PubMed  Google Scholar 

  26. Bogachev-Prokophiev AV, Ovcharov MA, Sapegin AV, Lavinykov SO, Astapov DA, Ivanzov SM, et al. Rigid ring versus flexible band for tricuspid valve repair in patients scheduled for mitral valve surgery: a prospective randomised study. Heart Lung Circ. 2021;30:1949–57.

    Article  PubMed  Google Scholar 

  27. Zhu TY, Wang JG, Meng X. Is a rigid tricuspid annuloplasty ring superior to a flexible band when correcting secondary tricuspid regurgitation? Interact Cardiovasc Thorac Surg. 2013;17:1009–14.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fukunaga N, Okada Y, Konishi Y, Murashita T, Koyama T. Late outcome of tricuspid annuloplasty using a flexible band/ring for functional tricuspid regurgitation. Circ J. 2015;79:1299–306.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Joseph M from Enago (www.enago.jp) for the English language review.

Funding

This research did not receive any specific graft from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Departments of Cardiac Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan

    Kazuki Noda, Naonori Kawamoto, Satoshi Kainuma, Naoki Tadokoro, Ayumi Ikuta & Satsuki Fukushima

Authors
  1. Kazuki Noda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naonori Kawamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Satoshi Kainuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naoki Tadokoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ayumi Ikuta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Satsuki Fukushima
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Writing: KN; Critical review and revision: all authors; Final approval of the article: all authors; Accountability for all aspects of the work: all authors.

Corresponding author

Correspondence to Naonori Kawamoto.

Ethics declarations

Conflict of interest

The authors declare that there are no conflicts of interest.

IRB information

Reporting were approved by the National Cerebral and Cardiovascular Center Institutional Review Board (reference number: M30-026).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Noda, K., Kawamoto, N., Kainuma, S. et al. Predictors of late outcomes after concomitant tricuspid valve repair with left-sided valve surgery. Gen Thorac Cardiovasc Surg (2024). https://doi.org/10.1007/s11748-024-02033-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11748-024-02033-x

Keywords

Search

Navigation