Abstract 3353: Surgical Treatment Versus Percutaneous Mitral Valvuloplasty in Mitral Stenosis With Severe Tricuspid Regurgitation
The persistence of significant tricuspid regurgitation (TR) after percutaneous mitral valvulo-plasty (PMV) is known as an independent predictor of adverse outcome in mitral stenosis (MS). However, it has been unclear whether mitral valve (MV) surgery combined with surgical correction of TR would be the better treatment option than PMV in patients with severe MS and severe functional TR.
Methods: We included a total of 92 consecutive patients (18 men, age; 49 ± 13 yrs) with severe MS and severe functional TR, who were potential candidates for PMV from 1997 to 2005, and the exclusion criteria were defined as the presence of left atrial thrombi, mitral regurgitation ≥ grade 3, echo score > 10, and ejection fraction (EF) <35%. PMV was performed in 48 patients (PMV group), and MV surgery combined with tricuspid valve repair (TVP) was performed in 44 patients (TVP group). Echocardiographic evaluation was performed before and after the procedure, and yearly during follow-up. The TR was defined as improved when TR was trace or mild on the 1 year follow-up echocardiography. The clinical events were defined as death, repeat surgery or PMV, and readmission due to heart failure.
Results: Baseline characteristics and clinical results were compared between two groups as shown in table⇓. There were 2 deaths, 5 MV surgery combined with TVP, 2 heart failure in PMV group, and 2 deaths in TVP group during follow-up, and the event rate of TVP group was significantly lower than PMV group despite its worse baseline characteristics (p < 0.05). The probability of event-free survival in TVP group was 98 ± 2% at 1 year and 95 ± 4% at 5 years and in PMV group 96 ± 3% at 1 year and 77 ± 8% at 5 years, respectively. On multiple Cox stepwise regression analysis, PMV group (p < 0.01) and lower EF (p < 0.05) were independently related with the clinical events.
Conclusions: Compared with PMV, MV surgery combined with TVP can improve TR more effectively and might be a preferable treatment option for severe MS associated with severe TR.