The Outcomes Of Tricuspid Valve Plasty For Mild Functional Tricuspid Regurgitation At The Time Of Mitral Valve Repair

Objective To review and explore the clinical outcomes of tricuspid valve plasty (TVP) formild functional tricuspid regurgitation at the time of mitral valvuloplasty (MVP).Methods According to undergoing combined TVP or not,106patients of mitralregurgitation due to myxomatous degeneration with mild functional tricuspid regurgitationfrom Jan2004to December2010in the Department of Cardiothoracic Surgery of SuzhouMunicipal Hospital and The Second Hospital Affiliated to Suzhou University were dividedinto the MVP group and the MVP+TVP group for the observation of cardiopulmonarybypass time, perioperative mortality rate, the degree of mitral regurgitation and the degreeof tricuspid regurgitation after operations, and the comparison of the survival and freedomfrom long-term moderate or severe mitral regurgitation and freedom from long-termmoderate or severe tricuspid regurgitation after operations, and the analysis of influencefactors of long-term moderate or severe tricuspid regurgitation after operations.Results (1) There was no significant difference on the cardiopulmonary bypass timebetween two groups, and the cardiopulmonary bypass time was88.6±14.7,91.6±16.2,respectively. In the perioperative period there was no death between two groups.Postoperative transthoracic echocardiography of all the survivors in the MVP groupindicated that mild mitral regurgitation was observed in7patients and trace regurgitationin20patients and no regurgitation in30patients, and in the MVP+TVP group mildregurgitation was observed in5patients and trace regurgitation in17patients and noregurgitation in27patients, and there was no significant difference on the mitralregurgitation between two groups. However, postoperative transthoracic echocardiographyof all the survivors in the MVP group indicated that tricuspid regurgitation was mild, andin the MVP+TVP group mild regurgitation was observed in12patients and trace regurgitation in17patients and no regurgitation in20patients, and there was significantdifference on the tricuspid regurgitation between two groups.(2) There was no significantdifference on the survival between two groups and survival at5years was97.5%,97.1%,respectively. There was no significant difference on the freedom from long-term moderateor severe mitral regurgitation after operations between two groups and the freedom frommoderate or severe mitral regurgitation at5years was98.2%,97.7%, respectively. Therewas significant difference on the freedom from long-term moderate or severe tricuspidregurgitation after operations between two groups and the freedom from moderate orsevere tricuspid regurgitation at5years was90.6%,97.4%, respectively.(3) Multivariatecox regression shows preoperative mean pulmonary artery pressure>30mmHg was theindependent risk factor for long-term moderate or severe tricuspid regurgitation afteroperations.Conclusion TVP is necessary for most patients undergoing MVP for mitral regurgitationdue to myxomatous degeneration who had coexistent mild functional tricuspidregurgitation, especially preoperatively mean pulmonary artery pressure>30mmHg.