Risk Factors of Secondary Tricuspid Regurgitation: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YU Cong ¹ ,  DONG Nianguo ¹ , SHI Jiawei ¹ , YIN Ping ²

1. Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;2. Department of Epidemiology and Health Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;

Corresponding author：

DONG Nianguo, Email: dongnianguo@hotmail.com

Keywords：

Heart valve surgery; Tricuspid regurgitation; Risk factor; Meta-analysis

DOI：

10.7507/1672-2531.20130253

Video：

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Objective 　To analyze and explore the risk factors of secondary tricuspid regurgitation (TR) after left-sided valve surgery (left cardiac valve replacement or valvuloplasty) using meta-analysis, so as to provide evidence for clinical diagnosis and treatment of secondary TR.
Methods 　We electronically searched databases including PubMed, MEDLINE, CBM, CNKI, VIP, for literature on the risk factors of secondary TR after left-sided valve surgery from 1995 to 2012. According to the inclusion and exclusion criteria, we screened literature, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software.
Results 　A total of 6 case-control studies were included, involving 437 patients and 2 102 controls. The results of meta-analysis showed that, the risk factors of progressive exacerbation of secondary TR after left-sided valve surgery included preoperative atrial fibrillation (OR=3.90, 95%CI 3.00 to 5.07; adjusted OR=3.04, 95%CI 2.21 to 4.16), age (MD=5.36, 95%CI 3.49 to 7.23), huge left atrium (OR=5.17, 95%CI 3.12 to 8.57; adjusted OR=1.91, 95%CI 1.49 to 2.44) or left atrium diameter (MD=4.85, 95%CI 3.18 to 6.53), degradation of left heart function (OR=2.97, 95%CI 1.73 to 5.08), rheumatic pathological change (OR=3.06, 95%CI 1.66 to 4.68), preoperative TR no less than 2+ (OR=3.52, 95%CI 1.26 to 9.89), and mitral valve replacement (MVR) (OR=2.35, 95%CI 1.68 to 3.30). Sex (OR=1.54, 95%CI 0.94 to 2.52) and preoperative pulmonary arterial hypertension (OR=1.28, 95%CI 0.77 to 2.12) were not associated with secondary TR after left-sided valve surgery.
Conclusion 　The risk factors of progressive exacerbation of secondary TR after left-sided valve surgery include preoperative atrial fibrillation, age, huge left atrium or left atrium diameter, degradation of left heart function, rheumatic pathological change, preoperative TR no less than 2+, and MVR. Understanding these risk factors helps us to improve the long-time effectiveness of preventing and treating TR after left-sided valve surgery.

Citation： YU Cong,DONG Nianguo,SHI Jiawei,YIN Ping. Risk Factors of Secondary Tricuspid Regurgitation: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(12): 1482-1491. doi: 10.7507/1672-2531.20130253 Copy

1.	Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis, 1992, 1(1): 80-86.
2.	Fukuda N, Oki T, Iuchi A, et al. Tricuspid inflow and regurgitant flow dynamics after mitral valve replacement: differences relating to surgical repair of the tricuspid valve. J Heart Valve Dis, 1997, 6(2): 184-188.
3.	Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis, 1999, 8(1): 57-62.
4.	Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studied in meta-analysis. http://www.ohri.ca/programs/clinical.Epide-miology/oxford.htm(accessed March 2005).
5.	王国华, 孙宗全, 张凯伦, 等. 继发性三尖瓣反流危险因素分析及外科治疗. 中华胸心血管外科杂志, 2007, 23(6): 374-377.
6.	魏丹, 孟旭, 李岩, 等. 左心瓣膜术后心房颤动与三尖瓣反流的关系. 心肺血管病杂志, 2012, 31(1):36-39.
7.	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.
8.	Kwak JJ, Kim YJ, Kim MK. Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations. Am Heart J, 2008, 155(4):732-737.
9.	Song H, Kim MJ, Chung CH, et al. Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery. Heart, 2009, 11(11): 931-936.
10.	García Fuster R, Vázquez A, Peláez AG, et al. Factors for development of late significant tricuspid regurgitation after mitral valve replacement: the impact of subvalvular preservation. Eur J Cardiothorac Surg, 2011, 39(6): 866-874.
11.	Vickers A, Goyal N, Harland R, et al. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials, 1998, 19(2): 159-166.
12.	麦劲壮, 李河, 方积乾, 等. Meta分析中失安全系数的估计. 循证医学, 2006, 6(5): 297-303.
13.	Raja SG, Dreyfus GD. Basis for Intervention on Functional tricuspid Regurgitation. Semin Thorac Cardiovasc Surg, 2010, 22(1): 79-83.
14.	Braunwald NS, Ross J Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation, 1967, 35(Suppl 4): I63-69.
15.	Simon R, Oelert H, Borst HG, et al. Influence of mitral valve surgery on tricuspid incompetence concomitant with mitral valve disease. Circulation, 1980, 62(2): 152-157.
16.	Izumi C, Iga K, Konishi T. Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis, 2002, 11(2): 353-356.
17.	Kim HK, Kim YJ, Kim KI, et al. Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time. Circulation, 2005, 112( Suppl 9): I14-19.
18.	Antunes MJ, Barlow JB. Management of tricuspid valve regurgitation. Heart, 2007, 93(2): 271-276.
19.	Benjamin EJ, D’Agostino RB, Belanger AJ, et al. Left atrial size and the risk of stroke and death. The Framingham heart study. Circulation, 1995, 92(4): 835-841.
20.	Stulak JM, Schaff HV, Dearani JA, et al. Restoration of sinus rhythm by the Maze procedure halts progression of tricuspid regurgitation after mitral surgery. Ann Thorac Surg, 2008, 86(1): 40-45.
21.	Xiao XJ, Huang HL, Zhang JF, et al. Surgical Treatment of Late Tricuspid regurgitation after left cardiac valve replacement. Heart Lung Circ, 2004, 13(1): 65-69.
22.	Kaul TK, Ramsdale DR, Mercer JL. Functional tricuspid regurgitation following replacement of the mitral valve. Int J Cardiol, 1991, 33(2): 305-313.

1. Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis, 1992, 1(1): 80-86.
2. Fukuda N, Oki T, Iuchi A, et al. Tricuspid inflow and regurgitant flow dynamics after mitral valve replacement: differences relating to surgical repair of the tricuspid valve. J Heart Valve Dis, 1997, 6(2): 184-188.
3. Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis, 1999, 8(1): 57-62.
4. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studied in meta-analysis. http://www.ohri.ca/programs/clinical.Epide-miology/oxford.htm(accessed March 2005).
5. 王国华, 孙宗全, 张凯伦, 等. 继发性三尖瓣反流危险因素分析及外科治疗. 中华胸心血管外科杂志, 2007, 23(6): 374-377.
6. 魏丹, 孟旭, 李岩, 等. 左心瓣膜术后心房颤动与三尖瓣反流的关系. 心肺血管病杂志, 2012, 31(1):36-39.
7. 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.
8. Kwak JJ, Kim YJ, Kim MK. Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations. Am Heart J, 2008, 155(4):732-737.
9. Song H, Kim MJ, Chung CH, et al. Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery. Heart, 2009, 11(11): 931-936.
10. García Fuster R, Vázquez A, Peláez AG, et al. Factors for development of late significant tricuspid regurgitation after mitral valve replacement: the impact of subvalvular preservation. Eur J Cardiothorac Surg, 2011, 39(6): 866-874.
11. Vickers A, Goyal N, Harland R, et al. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials, 1998, 19(2): 159-166.
12. 麦劲壮, 李河, 方积乾, 等. Meta分析中失安全系数的估计. 循证医学, 2006, 6(5): 297-303.
13. Raja SG, Dreyfus GD. Basis for Intervention on Functional tricuspid Regurgitation. Semin Thorac Cardiovasc Surg, 2010, 22(1): 79-83.
14. Braunwald NS, Ross J Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation, 1967, 35(Suppl 4): I63-69.
15. Simon R, Oelert H, Borst HG, et al. Influence of mitral valve surgery on tricuspid incompetence concomitant with mitral valve disease. Circulation, 1980, 62(2): 152-157.
16. Izumi C, Iga K, Konishi T. Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis, 2002, 11(2): 353-356.
17. Kim HK, Kim YJ, Kim KI, et al. Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time. Circulation, 2005, 112( Suppl 9): I14-19.
18. Antunes MJ, Barlow JB. Management of tricuspid valve regurgitation. Heart, 2007, 93(2): 271-276.
19. Benjamin EJ, D’Agostino RB, Belanger AJ, et al. Left atrial size and the risk of stroke and death. The Framingham heart study. Circulation, 1995, 92(4): 835-841.
20. Stulak JM, Schaff HV, Dearani JA, et al. Restoration of sinus rhythm by the Maze procedure halts progression of tricuspid regurgitation after mitral surgery. Ann Thorac Surg, 2008, 86(1): 40-45.
21. Xiao XJ, Huang HL, Zhang JF, et al. Surgical Treatment of Late Tricuspid regurgitation after left cardiac valve replacement. Heart Lung Circ, 2004, 13(1): 65-69.
22. Kaul TK, Ramsdale DR, Mercer JL. Functional tricuspid regurgitation following replacement of the mitral valve. Int J Cardiol, 1991, 33(2): 305-313.

Chinese Journal of Evidence-Based Medicine

Risk Factors of Secondary Tricuspid Regurgitation: A Meta-Analysis

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