Korean J Thorac Cardiovasc Surg.  2020 Dec;53(6):325-331. 10.5090/kjtcs.19.075.

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

• Choi JW
• Kim KH
• Lim SC
• Kim SH
• Sohn SH
• Lee Y
• Hwang HY

• KMID: 2509402
• DOI: http://doi.org/10.5090/kjtcs.19.075

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/㎡ 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/m 2 .

Keyword

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