A Randomized Controlled Trial of Concomitant Tricuspid Annuloplasty for Patients Underwent Mitral Valve Replacement: UCG Evaluation 2 Years After Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DENGYun-dan ¹ , LIYong-bo ² , QIANYong-jun ¹ , HEFan ³ , LINFu-shun ¹ , TANGHong ⁴ , LIUGuan-jian ⁵ ,  XIAOXi-jun ¹

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Cardiovascular Surgery, Yan'an Hospital, Kunming 650051, P. R. China;
3. Department of Cardiac Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, P. R. China;
4. Department of Echocardiography, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
5. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

XIAOXi-jun, Email: dr_xijunxiao@163.com

Keywords：

Heart valve disease; Mitral valve replacement; Tricuspid regurgitation; Tricuspid valve annulus dilation; Tricuspid valve annuloplasty; Function of right ventricle

DOI：

10.7507/1007-4848.20160159

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Objective To evaluate the right ventricular function of the patients 2 years after surgery by ultrasonic cardiography (UCG) who underwent mitral valve replacement (MVR) concomitant tricuspid annuloplasty (TAP). Method We finally identified 36 patients required MVR with tricuspid valve annular dilation concomitant merely mild tricuspid regurgitaion (TR) based on preoperative UCG in our hospital between April and November 2012 year. All patients were randomly divided into two groups by digital table including a tricuspid annuloplasty group (a TAP group, n=18, 7 males and 11 females at age of 45.67±12.49 years) and a no-tricuspid annuloplasty group (a NTAP group, n=18, 6 males and 12 females at age of 45.44±10.48 years). General clinical data and extracorporeal circulation data were recorded. UCG evaluation was practiced preoperation, alone with 1 week, 6 months, and 2 years after surgery. Results Two years postoperative maximal long-axis of RA (RA_mla), mid-RA minor distance (RA_mmd), right ventricle dimension-1(RVD1) , right ventricular fractional area change (RVFAC), 3D RV end-systolic volume (3DRVESV), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) of patients were all smaller in the TAP group than those in the NTAP group. Yet right ventricular ejection fraction (RVEF), percent shorting of tricuspid valve annulus (PSTVA) were greater in the TAP group than those in the NTAP group, although there was no statistical difference between the two groups in two years postoperative 3D RV end-diastolic volume (3DRVEDV). The patients in the TAP group had a superior trend than that of the NTAP group. Moreover, the patients' TR constituent ratio in the TAP group was much better than that of the NTAP group in 2 year after operation. Conclusions Concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR is favorable for the recovery of their 2 years postoperative function of tricuspid valve and right ventricle. It is benefit to reduce patient's long term postoperative TR residues and exacerbation.

Citation： DENGYun-dan, LIYong-bo, QIANYong-jun, HEFan, LINFu-shun, TANGHong, LIUGuan-jian, XIAOXi-jun. A Randomized Controlled Trial of Concomitant Tricuspid Annuloplasty for Patients Underwent Mitral Valve Replacement: UCG Evaluation 2 Years After Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 658-665. doi: 10.7507/1007-4848.20160159 Copy

1.	Boyaci A, Gokce V, Topaloglu S, et al. Outcome of significant functional tricuspid regurgitation late after mitral valve replacement for predominant rheumatic mitral stenosis. Angiology, 2007, 58(3) :336-342.
2.	肖锡俊, 袁宏声, 唐红, 等. 二尖瓣置换术后三尖瓣反流的逆转、残留或加重. 中国胸心血管外科临床杂志, 2006, 13(5) :307-310.
3.	李永波, 唐红, 梁春水, 等. 三尖瓣瓣环扩张伴轻度反流的二尖瓣置换术患者同期行三尖瓣成形术的随机对照试验. 中国胸心血管外科临床杂志, 2015, 22(6) :518-525.
4.	Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis, 1992, 1(1) :80-86.
5.	Colombo T, Russo C, Ciliberto GR, et al. Tricuspid regurgitation secondary to mitral valve disease:tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg, 2001, 9(4) :369-377.
6.	Wang J, Li Z, Zhu Q, et al. A modified tricuspid valve annuloplasty technique for functional tricuspid regurgitation. Chin Med J (Engl), 2013, 126(18) :3534-3538.
7.	Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardio-graphic assessment of the right heart in adults:a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr, 2010, 23(7) :685-713; quiz 786-788.
8.	Chopra HK, Nanda NC, Fan P, et al. Can two-dimensional echocar-diography and Doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol, 1989, 14(5) :1266-1274.
9.	向波, 唐红, 周文霞, 等. 二尖瓣置换加三尖瓣成形术前后右房室径、房室环变化及临床意义. 四川大学学报(医学版), 2009, 40(3) :490-494.
10.	Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2012, 143(3) :632-638.
11.	Irwin RB, Luckie M, Khattar RS. Tricuspid regurgitation:contem-porary management of a neglected valvular lesion. Postgrad Med J, 2010, 86(1021) :648-655.
12.	Di Mauro M, Bezante GP, Di Baldassarre A, et al. Functional tricu-spid regurgitation:an underestimated issue. Int J Cardiol, 2013, 168(2) :707-715.
13.	Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgi-tation or dilatation:which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1) :127-132.
14.	Tornos Mas P, Rodriguez-Palomares JF, Antunes MJ, et al. Secondary tricuspid valve regurgitation:a forgotten entity. Heart, 2015, 101(22) :1840-1844.
15.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guide-line for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(23) :e521-643.
16.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the manage-ment of valvular heart disease (version 2012) :the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4) :S1-44.
17.	Naqshband MS, Abid AR, Akhtar RP, et al. Functional tricuspid regurgitation in rheumatic heart disease:surgical options. Ann Thorac Cardiovasc Surg, 2010, 16(6) :417-425.
18.	Smid M, Cech J, Rokyta R, et al. Mild to moderate functional tricuspid regurgitation:retrospective comparison of surgical and conservative treatment. Cardiol Res Pract, 2010, 2010. pii:143878.
19.	Desai RR, Vargas Abello LM, Klein AL, et al. Tricuspid regurgita-tion and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. J Thorac Cardiovasc Surg, 2013, 146(5) :1126-1132 e10.
20.	Hui W, Abd El Rahman MY, Dsebissowa F, et al. Comparison of modified short axis view and apical four chamber view in evaluating right ventricular function after repair of tetralogy of Fallot. Int J Cardiol, 2005, 105(3) :256-261.
21.	Chen G, Sun K, Huang G. In vitro validation of right ventricular volume and mass measurement by real-time three-dimensional echocardiography. Echocardiography, 2006, 23(5) :395-399.
22.	王帆顺. 超声技术对功能性三尖瓣关闭不全患者手术前、后右心室功能的评估. 复旦大学硕士学位论文, 2009.
23.	朱鹏, 肖锡俊, 唐红, 等. 以三尖瓣瓣环径作为三尖瓣成形手术指征的初步临床观察. 中国胸心血管外科临床杂志, 2008, 15(4) :245-248.
24.	Foale R, Nihoyannopoulos P, Mckenna W, et al. Echocardiographic measurement of the normal adult right ventricle. Br Heart J, 1986, 56(1) :33-44.
25.	Van De Veire NR, Braun J, Delgado V, et al. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation under-going mitral valve repair. J Thorac Cardiovasc Surg, 2011, 141(6) :1431-1439.
26.	Rogers JH, Bolling SF. Valve repair for functional tricuspid valve regurgitation:anatomical and surgical considerations. Semin Thorac Cardiovasc Surg, 2010, 22(1) :84-89.
27.	Van Der Zwaan HB, Geleijnse ML, Mcghie JS, et al. Right ventri-cular quantification in clinical practice:two-dimensional vs. three-dimensional echocardiography compared with cardiac magnetic resonance imaging. Eur J Echocardiogr, 2011, 12(9) :656-664.
28.	Tamborini G, Muratori M, Brusoni D, et al. Is right ventricular systolic function reduced after cardiac surgery? A two-and three-dimensional echocardiographic study. Eur J Echocardiogr, 2009, 10(5) :630-634.
29.	Larrazet F, Czitrom D, Laborde F, et al. Decreased right ventricular lateral wall velocities early after cardiac surgery. Echocardiography, 2011, 28(4) :438-441.
30.	Lopez-Candales A, Rajagopalan N, Saxena N, et al. Right ventricular systolic function is not the sole determinant of tricuspid annular motion. Am J Cardiol, 2006, 98(7) :973-977.
31.	Matsuyama K, Matsumoto M, Sugita T, et al. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg, 2003, 75(6) :1826-1828.
32.	Park JH, Shin SH, Lee MJ, et al. Clinical and echocardiographic factors affecting tricuspid regurgitation severity in the patients with lone atrial fibrillation. J Cardiovasc Ultrasound, 2015, 23(3) :136.
33.	Kim HK, Kim YJ, Park JS, et al. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol, 2006, 98(2) :236-242.

1. Boyaci A, Gokce V, Topaloglu S, et al. Outcome of significant functional tricuspid regurgitation late after mitral valve replacement for predominant rheumatic mitral stenosis. Angiology, 2007, 58(3) :336-342.
2. 肖锡俊, 袁宏声, 唐红, 等. 二尖瓣置换术后三尖瓣反流的逆转、残留或加重. 中国胸心血管外科临床杂志, 2006, 13(5) :307-310.
3. 李永波, 唐红, 梁春水, 等. 三尖瓣瓣环扩张伴轻度反流的二尖瓣置换术患者同期行三尖瓣成形术的随机对照试验. 中国胸心血管外科临床杂志, 2015, 22(6) :518-525.
4. Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis, 1992, 1(1) :80-86.
5. Colombo T, Russo C, Ciliberto GR, et al. Tricuspid regurgitation secondary to mitral valve disease:tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg, 2001, 9(4) :369-377.
6. Wang J, Li Z, Zhu Q, et al. A modified tricuspid valve annuloplasty technique for functional tricuspid regurgitation. Chin Med J (Engl), 2013, 126(18) :3534-3538.
7. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardio-graphic assessment of the right heart in adults:a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr, 2010, 23(7) :685-713; quiz 786-788.
8. Chopra HK, Nanda NC, Fan P, et al. Can two-dimensional echocar-diography and Doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol, 1989, 14(5) :1266-1274.
9. 向波, 唐红, 周文霞, 等. 二尖瓣置换加三尖瓣成形术前后右房室径、房室环变化及临床意义. 四川大学学报(医学版), 2009, 40(3) :490-494.
10. Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2012, 143(3) :632-638.
11. Irwin RB, Luckie M, Khattar RS. Tricuspid regurgitation:contem-porary management of a neglected valvular lesion. Postgrad Med J, 2010, 86(1021) :648-655.
12. Di Mauro M, Bezante GP, Di Baldassarre A, et al. Functional tricu-spid regurgitation:an underestimated issue. Int J Cardiol, 2013, 168(2) :707-715.
13. Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgi-tation or dilatation:which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79(1) :127-132.
14. Tornos Mas P, Rodriguez-Palomares JF, Antunes MJ, et al. Secondary tricuspid valve regurgitation:a forgotten entity. Heart, 2015, 101(22) :1840-1844.
15. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guide-line for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(23) :e521-643.
16. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the manage-ment of valvular heart disease (version 2012) :the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4) :S1-44.
17. Naqshband MS, Abid AR, Akhtar RP, et al. Functional tricuspid regurgitation in rheumatic heart disease:surgical options. Ann Thorac Cardiovasc Surg, 2010, 16(6) :417-425.
18. Smid M, Cech J, Rokyta R, et al. Mild to moderate functional tricuspid regurgitation:retrospective comparison of surgical and conservative treatment. Cardiol Res Pract, 2010, 2010. pii:143878.
19. Desai RR, Vargas Abello LM, Klein AL, et al. Tricuspid regurgita-tion and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. J Thorac Cardiovasc Surg, 2013, 146(5) :1126-1132 e10.
20. Hui W, Abd El Rahman MY, Dsebissowa F, et al. Comparison of modified short axis view and apical four chamber view in evaluating right ventricular function after repair of tetralogy of Fallot. Int J Cardiol, 2005, 105(3) :256-261.
21. Chen G, Sun K, Huang G. In vitro validation of right ventricular volume and mass measurement by real-time three-dimensional echocardiography. Echocardiography, 2006, 23(5) :395-399.
22. 王帆顺. 超声技术对功能性三尖瓣关闭不全患者手术前、后右心室功能的评估. 复旦大学硕士学位论文, 2009.
23. 朱鹏, 肖锡俊, 唐红, 等. 以三尖瓣瓣环径作为三尖瓣成形手术指征的初步临床观察. 中国胸心血管外科临床杂志, 2008, 15(4) :245-248.
24. Foale R, Nihoyannopoulos P, Mckenna W, et al. Echocardiographic measurement of the normal adult right ventricle. Br Heart J, 1986, 56(1) :33-44.
25. Van De Veire NR, Braun J, Delgado V, et al. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation under-going mitral valve repair. J Thorac Cardiovasc Surg, 2011, 141(6) :1431-1439.
26. Rogers JH, Bolling SF. Valve repair for functional tricuspid valve regurgitation:anatomical and surgical considerations. Semin Thorac Cardiovasc Surg, 2010, 22(1) :84-89.
27. Van Der Zwaan HB, Geleijnse ML, Mcghie JS, et al. Right ventri-cular quantification in clinical practice:two-dimensional vs. three-dimensional echocardiography compared with cardiac magnetic resonance imaging. Eur J Echocardiogr, 2011, 12(9) :656-664.
28. Tamborini G, Muratori M, Brusoni D, et al. Is right ventricular systolic function reduced after cardiac surgery? A two-and three-dimensional echocardiographic study. Eur J Echocardiogr, 2009, 10(5) :630-634.
29. Larrazet F, Czitrom D, Laborde F, et al. Decreased right ventricular lateral wall velocities early after cardiac surgery. Echocardiography, 2011, 28(4) :438-441.
30. Lopez-Candales A, Rajagopalan N, Saxena N, et al. Right ventricular systolic function is not the sole determinant of tricuspid annular motion. Am J Cardiol, 2006, 98(7) :973-977.
31. Matsuyama K, Matsumoto M, Sugita T, et al. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg, 2003, 75(6) :1826-1828.
32. Park JH, Shin SH, Lee MJ, et al. Clinical and echocardiographic factors affecting tricuspid regurgitation severity in the patients with lone atrial fibrillation. J Cardiovasc Ultrasound, 2015, 23(3) :136.
33. Kim HK, Kim YJ, Park JS, et al. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol, 2006, 98(2) :236-242.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

A Randomized Controlled Trial of Concomitant Tricuspid Annuloplasty for Patients Underwent Mitral Valve Replacement: UCG Evaluation 2 Years After Surgery

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