Fate of functional tricuspid regurgitation after mitral valve repair for degenerative mitral regurgitation.
(35/45)
BACKGROUND: The issue of whether functional tricuspid regurgitation (TR) should be repaired at the time of mitral valve surgery is controversial, and the long-term durability of tricuspid valve (TV) annuloplasty remains unknown. METHODS AND RESULTS: We retrospectively reviewed 654 patients who underwent mitral valve repair for degenerative mitral regurgitation between 1991 and 2010. Preoperative TR was classed as mild, trivial or absent in 479 (73.2%) patients, moderate in 125 (19.1%) patients and severe in 50 (7.7%) patients. Concomitant TV annuloplasty was performed in 162 patients (24.8%). The mean follow up duration was 7.5+/-4.9 years. Postoperative transthoracic echocardiography was performed according to a fixed schedule. The long-term survival rate and freedom from re-admission for congestive heart failure were affected by the severity of TR. Although the durability of ring annuloplasty was excellent up to 10 years after surgery, the mean TR grade started to increase after 10 years. Sixteen out of 492 patients who did not undergo TV annuloplasty (3.2%) revealed progression to severe TR. Preoperative atrial fibrillation (odds ratio (OR), 4.85; 95% confidence interval (CI), 1.38-17.1; P=0.014) and preoperative TR grade (OR, 5.16; 95% CI, 1.78-14.9; P=0.003) were predictors for progression to severe TR. CONCLUSIONS: Aggressive treatment with concomitant TV annuloplasty should be advocated in cases with atrial fibrillation and more than moderate TR. (+info)
Proposal of a novel index for selection of optimal annuloplasty ring size for tricuspid annuloplication.
(37/45)
BACKGROUND: Optimal ring size in tricuspid annuloplasty (TAP) surgery to treat functional tricuspid regurgitation (TR) was investigated because optimal ring size remains undefined. METHODS AND RESULTS: Sixty seven patients who underwent TAP at our institution were retrospectively studied. Tricuspid Annuloplasty Ring size Index (TARI) was defined as implanted tricuspid annuloplasty ring size divided by body surface area (BSA). Different TARI cut-off values were tested to determine which value produced the greatest difference in TR improvement (TRI=preoperative minus postoperative TR grade) between patients with TARI smaller (group S) and larger (group L) than the cut-off. Group S was also subdivided by ring type: Cosgrove rings (SC) and MC3 rings (SM). TARI and TRI were negatively correlated (r=-0.307). A TARI threshold of 18.9 mm/m(2) produced the greatest and most significant difference (P<0.0005) in TRI. Defining groups S and L using this threshold, TRI was significantly greater for group S (1.77 +/- 0.80) than for group L (0.97 +/- 0.83); P <0.0005. There was no difference in TRI between groups SC and SM. CONCLUSIONS: A novel index TARI that normalizes tricuspid annuloplasty ring size by BSA was developed. Choosing ring size to make TARI <18.9 mm/m(2) is likely to be better than setting an upper limit of absolute ring size in the surgical treatment of TR. (+info)
Cardiopulmonary bypass after severe blunt hepatic injury: management of multi-system blunt trauma in an adolescent.
(38/45)