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Optimal Tricuspid Annular Size for Tricuspid Annuloplasty in Patients with Less-Than-Moderate Functional Tricuspid Regurgitation

최재웅, 김경환, 임수찬, 김수현, 손석호, 이예원, 황호영,
소속 상세정보
최재웅 ( Choi Jae-Woong ) - Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
김경환 ( Kim Kyung-Hwan ) - Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
임수찬 ( Lim Su-Chan ) - Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
김수현 ( Kim Sue-Hyun ) - Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
손석호 ( Sohn Suk-Ho ) - Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
이예원 ( Lee Yei-Won ) - Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
황호영 ( Hwang Ho-Young ) - Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery

Abstract


Background: We evaluated the association between tricuspid annular dilatation and the development of moderate or severe tricuspid regurgitation (TR). Additionally, we determined the optimal tricuspid annular dilatation threshold to use as an indicator for tricuspid annuloplasty in patients with less-than-moderate functional TR (FTR).

Methods: Between August 2007 and December 2014, 227 patients with less-than-moderate TR underwent mitral valve surgery without a tricuspid valve (TV) procedure. The TV annular diameter was measured via transthoracic echocardiography. The TV annular index (TVAI) was calculated as the TV annular diameter divided by the body surface area. The mean duration of echocardiographic follow-up was 42.0 months (interquartile range, 9.3?66.6 months).

Results: Eight patients (3.5%) developed moderate or severe TR. The rate of freedom from development of moderate or severe TR at 5 years was 96.2%. TV annular diameter, left atrial diameter, preoperative atrial fibrillation, and TVAI were found to be associated with the development of moderate or severe TR in the univariate analysis. A cut-off TVAI value of 19.8 mm/m2 was found to predict the development of moderate or severe TR, and a significant difference was observed in the development of TR of this severity based on this cut-off (p<0.001).

Conclusion: The progression of TR was not infrequent in patients with untreated lessthan- moderate FTR. An aggressive treatment approach can be helpful to prevent the progression of FTR for patients with risk factors, especially TVAI greater than 19.8 mm/m2.

키워드

Valve disease; Tricuspid valve; Tricuspid valve surgery; Tricuspid valve insufficiency

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