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J Thorac Cardiovasc Surg 2011;142:308-313
© 2011 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Echocardiographic-based treatment of functional tricuspid regurgitation

^a Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
^b Division of Cardiac Surgery, Ferrarotto Hospital, University of Catania, Catania, Italy
^c Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
^d Institute of Cardiovascular Disease, University of L'Aquila, L'Aquila, Italy

Received for publication January 6, 2010; revisions received March 30, 2010; accepted for publication April 16, 2010.

^_* Address for reprints: Antonio M. Calafiore, MD, Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia. (Email: calafiore{at}unich.it).

Objectives: Functional tricuspid regurgitation (FTR) worsens over time, and its natural history is unfavorable. An aggressive surgical strategy, using the echocardiographic systolic dimensions of the tricuspid annulus (sysTA), can be helpful to reduce the detrimental late effects of FTR.

Methods: From March 2006 to February 2008, 298 patients, with at least FTR grade 1+, underwent mitral valve surgery. Of these 298 patients, 167 underwent tricuspid repair (treated group [T], moderate-or-greater FTR in 108 and mild in 59, with sysTA > 24 mm) and 137 did not (untreated group [UT], moderate-or-greater FTR in 16 and mild in 115; 81 with sysTA > 24 mm and 34 with sysTA of 24 mm). The 256 survivors underwent echocardiographic examination at a mean follow-up of 13 ± 8 months.

Results: Preoperatively, at discharge, and at the follow-up examination, the mean FTR grade was 1.11 ± 0.32, 0.87 ± 0.49, and 1.03 ± 0.57 (P = NS) in the UT group and 2.11 ± 0.92, 0.45 ± 0.36, and 0.48 ± 0.32 (P < .001) in the T group. A total of 24 patients had FTR grade 2 or greater, 16 (14.5%) in the UT group and 8 (5.5%) in the T group (P = .026). In the UT group, 10 of 16 patients had sysTA of 25 to 28 mm and 6 of 10 had sysTA greater than 28 mm. No patient with mild FTR and sysTA of 24 mm or less had an increased FTR grade. Globally, 12 patients (10.9%) had an increased FTR grade in the UT group versus none in the T group (P < .001). Patients with postoperative atrial fibrillation had less residual FTR if annuloplasty had been performed (1.6 ± 0.7 vs 0.91 ± 0.63, P = .005).

Conclusions: An aggressive strategy for FTR correction, using the sysTA, was able to reduce the FTR grade 1 year after surgery, but mitral surgery alone could not.

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