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Eur J Cardiothorac Surg 2008;33:600-606. doi:10.1016/j.ejcts.2008.01.011
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Michele De Bonis
Elisabetta Lapenna
Francesco Maisano
Lucia Torracca
Ottavio Alfieri
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Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy

Michele De Bonis*, Elisabetta Lapenna, Flavia Sorrentino, Giovanni La Canna, Antonio Grimaldi, Francesco Maisano, Lucia Torracca, Ottavio Alfieri

Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy

Received 3 September 2007; received in revised form 3 January 2008; accepted 8 January 2008.

* Corresponding author. Tel.: +39 0226437102; fax: +39 0226437125. (Email: michele.debonis{at}hsr.it).

Objective: To assess the evolution of tricuspid regurgitation (TR) in dilated cardiomyopathy (DCM) patients submitted to mitral repair for functional mitral regurgitation (MR). Methods: Ninety-one DCM patients (mean age 61 ± 11.3) submitted to MV repair (±tricuspid repair) for functional MR were included. Preoperative EF was 30.9 ± 6.5%, left ventricular (LV) end-diastolic volume 113 ± 31.5 ml/m2, LV end-systolic volume 81.8 ± 26.7 ml/m2, functional MR ≥3+/4+. TR was classified as ≤1+/4+ in 57 patients (62.6%), 2+/4+ in 21 (23%) and ≥3+/4+ in 13 (14.2%). Most of the patients were in NYHA class III or IV. A tricuspid annuloplasty was associated to mitral repair whenever preoperative TR was ≥3+. Therefore 13 patients (14.2%) underwent concomitant tricuspid annuloplasty whereas the remaining 78 (with preoperative TR ≤2+) did not. Results: At follow-up (mean 1.8 ± 1.2 years), 12% of the patients (11/91) had still 3–4+ TR due to failure of the tricuspid repair or progression of untreated ≤2+ TR. Freedom from TR ≥3+ was 78 ± 8.8% at 3.5 years. Among the 78 patients not submitted to tricuspid repair, 14 (18%) showed a progression of TR severity equal or greater than two grades. The multivariate analysis identified grade of TR at discharge (OR 5.4, p = 0.01) and preoperative RV dysfunction (OR 19.6, p = 0.02) as the only independent predictors of TR ≥3+/4+ at follow-up. Conclusions: A significant number of patients submitted to mitral repair for functional MR present ≥3+ TR at follow-up as consequence of progression of untreated TR or failure of tricuspid repair. A more aggressive and effective treatment of functional TR in this setting should be pursued.

Key Words: Functional tricuspid regurgitation • Functional mitral regurgitation • Dilated cardiomyopathy




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Copyright © 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.