Abstract 10182: Right Ventricular Function After Mitral Valve Surgery With or Without Concomitant Tricuspid Valve Procedure
Background: Functional tricuspid valve regurgitation (TR) accompanying mitral valve disease is associated with right ventricular (RV) dysfunction. Our objectives were to study RV function after mitral valve surgery with or without a concomitant tricuspid valve (TV) procedure.
Methods: From 2001 to 2007, 1,833 patients with degenerative mitral valve disease, structurally normal TV, and no coronary artery disease underwent surgery. RV function (myocardial performance index [MPI] and tricuspid anular plane systolic excursion [TAPSE]) were measured before and after surgery on transthoracic echocardiograms for 100 randomly selected patients from each of the TR grades 0, 1+, and 2+, and for all 93 with 3+/4+, 393 patients in total. Sixty-seven had a concomitant TV procedure. Separate multivariable longitudinal (repeated-measures) modeling and regression analyses were used to evaluate the temporal trend of RV function.
Results: A TV procedure effectively reduced TR to levels comparable to patients with no TV procedure (Figure, left). RV dysfunction increased early after surgery in the no-TV-procedure group, but then improved to levels just above normal (0.4 for MPI; Figure, right). In contrast, RV function improved substantially in the TV-procedure group, reaching levels similar to those of the no-TV-procedure group within a few months after surgery. TAPSE behaved similarly to MPI.
Conclusions: Mitral valve surgery induced mild immediate RV dysfunction, which improved over time but never fully reached preoperative level. Patients with severe TR and RV dysfunction undergoing a concomitant TV procedure showed improved RV function immediately after surgery and eventually recovered RV function comparable to that in the no-TV-procedure patients. Fixing severe TR improves RV function.
- © 2010 by American Heart Association, Inc.