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(Circulation. 2006;114:I-582 – I-587.)
© 2006 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Determinants of Recurrent or Residual Functional Tricuspid Regurgitation After Tricuspid Annuloplasty

Shota Fukuda, MD; A. Marc Gillinov, MD; Patrick M. McCarthy, MD; William J. Stewart, MD; Jong-Min Song, MD; Takashi Kihara, MD; Masao Daimon, MD; Mi-Seong Shin, MD; James D. Thomas, MD; Takahiro Shiota, MD

From the Department of Cardiovascular Medicine (S.F., W.J.S., J.-M.S., T.K., M.D., M.-S.S., J.D.T., T.S.), Cleveland Clinic Foundation, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery (A.M.G.), Cleveland Clinic Foundation, Cleveland, Ohio; Northwestern University’s Feinberg School of Medicine/Bluhm Cardiovascular Institute (P.M.M.), Chicago, Ill.

Correspondence to Takahiro Shiota, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F15, Cleveland, OH 44195. E-mail shiotat{at}ccf.org

Background— The durability of tricuspid valve (TV) repair by annuloplasty is limited. Identification of mechanisms of recurrent or residual tricuspid regurgitation (TR) after annuloplasty is necessary to improve results of TV repair. The purpose of this study was to investigate echocardiographic determinants of mid-term outcome after TV annuloplasty.

Methods and Results— This study consisted of 39 patients with functional TR who had echocardiography preoperatively, early postoperatively (5±2 days), and >1 year (20±6 months) after TV annuloplasty. Detailed echocardiographic measurements were performed, including TR severity, TV annular dimension, TV leaflet displacement, left ventricular (LV) function, and right ventricular (RV) function and pressures. Preoperative leaflet tethering height and area predicted early and mid-term outcome of annuloplasty. Early postoperative LV ejection fraction and TR severity influenced degree of TR >1 year after surgery. In addition, increased RV pressure was related to worse TR during late follow-up.

Conclusions— Although TV tethering is an important determinant of recurrent or residual TR, LV and RV function and pressures impact repair durability. These factors identify patients at risk for repair failure; such individuals require development of additional surgical strategies to improve results of tricuspid valve repair and close surveillance after surgery.

Key Words: echocardiography • regurgitation • surgery • valves

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