Outcomes of Mild to Moderate Functional Tricuspid Regurgitation in Patients Undergoing Mitral Valve Operations: A Meta-Analysis of 2,488 Patients
2015; Elsevier BV; Volume: 100; Issue: 6 Linguagem: Inglês
10.1016/j.athoracsur.2015.07.024
ISSN1552-6259
Autoresİbrahim Kara, Cengiz Köksal, Alper Erkin, Hakan Saçlı, Mücahit Demirtaş, Bilal Perçin, Mevriye Serpil Diler, Kaan Kırali,
Tópico(s)Cardiac Structural Anomalies and Repair
ResumoThis meta-analysis examined the prognosis of patients who were found to have mild to moderate functional tricuspid regurgitation during mitral valve operations. Overall, this meta-analysis included 2,488 patients in 10 studies. Compared with the group without tricuspid valve annuloplasty, the probability of not progressing to moderate to severe functional tricuspid regurgitation was significantly higher in the tricuspid valve annuloplasty group. A more aggressive surgical approach involving concomitant tricuspid repair with mitral valve operations may be considered to avoid the development of moderate to severe functional tricuspid regurgitation in the follow-up. This meta-analysis examined the prognosis of patients who were found to have mild to moderate functional tricuspid regurgitation during mitral valve operations. Overall, this meta-analysis included 2,488 patients in 10 studies. Compared with the group without tricuspid valve annuloplasty, the probability of not progressing to moderate to severe functional tricuspid regurgitation was significantly higher in the tricuspid valve annuloplasty group. A more aggressive surgical approach involving concomitant tricuspid repair with mitral valve operations may be considered to avoid the development of moderate to severe functional tricuspid regurgitation in the follow-up. Left-sided valvular heart diseases represent the most common cause of functional tricuspid regurgitation (FTR) [1Dreyfus G.D. Corbi P.J. Chan K.M. Bahrami T. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair?.Ann Thorac Surg. 2005; 79: 127-132Abstract Full Text Full Text PDF PubMed Scopus (672) Google Scholar]. The reported prevalence of FTR in patients undergoing operations for left-sided heart valve disease is 25% to 30% [2King R.M. Schaff H.V. Danielson G.K. et al.Surgery for tricuspid regurgitation late after mitral valve replacement.Circulation. 1984; 70: 193-197PubMed Google Scholar, 3Cohen S.R. Sell J.E. McIntosh C.L. Clark R.E. Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation. II. Nonoperative management, tricuspid valve annuloplasty, and tricuspid valve replacement.J Thorac Cardiovasc Surg. 1987; 94: 488-497PubMed Google Scholar, 4Simon R. Oelert H. Borst H.G. Lichtlen P.R. Influence of mitral valve surgery on tricuspid incompetence concomitant with mitral valve disease.Circulation. 1980; 62: 152-157PubMed Google Scholar, 5Raja S.G. Dreyfus G.D. Basis for intervention on functional tricuspid regurgitation.Semin Thorac Cardiovasc Surg. 2010; 22: 79-83Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar]. Right ventricular (RV) dilatation and annular dilatation result in coaptation deficiency and tethering of leaflets of the tricuspid valve. Historically, conservative strategies have been recommended for FTR in patients undergoing left-sided heart valve operations [6Braunwald N.S. Ross Jr., J. Morrow A.G. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement.Circulation. 1967; 35: 63-69Crossref PubMed Google Scholar]. Over the years, late FTR has been reported in patients after isolated mitral valve operations, with substantial morbidity and mortality rates [1Dreyfus G.D. Corbi P.J. Chan K.M. Bahrami T. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair?.Ann Thorac Surg. 2005; 79: 127-132Abstract Full Text Full Text PDF PubMed Scopus (672) Google Scholar, 3Cohen S.R. Sell J.E. McIntosh C.L. Clark R.E. Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation. II. Nonoperative management, tricuspid valve annuloplasty, and tricuspid valve replacement.J Thorac Cardiovasc Surg. 1987; 94: 488-497PubMed Google Scholar, 7Porter A. Shapira Y. Wurzel M. et al.Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation.J Heart Valve Dis. 1999; 8: 57-62PubMed Google Scholar, 8De Bonis M. Lapenna E. Sorrentino F. et al.Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy.Eur J Cardiothorac Surg. 2008; 33: 600-606Crossref PubMed Scopus (97) Google Scholar, 9Kwon D.A. Park J.S. Chang H.J. et al.Prediction of outcome in patients undergoing surgery for severe tricuspid regurgitation following mitral valve surgery and role of tricuspid annular systolic velocity.Am J Cardiol. 2006; 98: 659-661Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar]. Guidelines have classified FTR based on anatomy, valve hemodynamics, hemodynamic consequences, and clinical symptoms [10Nishimura R.A. Otto C.M. Bonow R.O. et al.2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 63: 2438-2488Abstract Full Text Full Text PDF PubMed Scopus (1430) Google Scholar]. Concomitant tricuspid valve repair or replacement at the time of the left-sided valvular operation has been recommended, with class I indication in patients with severe FTR to improve long-term clinical outcomes [10Nishimura R.A. Otto C.M. Bonow R.O. et al.2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014; 63: 2438-2488Abstract Full Text Full Text PDF PubMed Scopus (1430) Google Scholar, 11Kuwaki K. Morishita K. Tsukamoto M. Abe T. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease.Eur J Cardiothorac Surg. 2001; 20: 577-582Crossref PubMed Scopus (80) Google Scholar]. Nonetheless, the optimal management of mild to moderate FTR remains controversial. We therefore performed a meta-analysis to examine the outcome of strategies used for the treatment of mild to moderate FTR in patients undergoing mitral valve operations. The literature search covered publications up to November 2014 in PubMed, MEDLINE, and Science Direct databases, as well as those in the Google Scholar electronic search engine. In addition, the studies listed in the reference lists of the reviews and studies were examined. The search keywords included the following combinations: “tricuspid valve insufficiency” or “tricuspid regurgitation” and “functional tricuspid” or “functional tricuspid regurgitation” and “mild functional tricuspid regurgitation” or “mild to moderate tricuspid regurgitation.” The following criteria were used for the inclusion of studies: (1) human studies published in English, (2) randomized or nonrandomized studies with a prospective or retrospective design, (3) studies that involved patients undergoing mitral valve operations with mild to moderate FTR (tricuspid valve regurgitation grade <3), (4) studies that involved mild to moderate FTR patients undergoing tricuspid valve annuloplasty (TVA) during the mitral valve operation as well as control patients, and (5) studies that involved patients who had no surgical intervention for mild to moderate FTR during the mitral valve operation with a follow-up for progression to moderate to severe FTR. Organic or rheumatoid tricuspid valve disorders, tricuspid valve endocarditis, congenital disorders of the tricuspid valve, leaflet deformity of the tricuspid valve (chorda rupture, leaflet tear, etc.), and a TR grade of 3 or higher were the exclusion criteria. In addition, studies with aortic valve operations or coronary artery bypass grafting, or both, in addition to mitral valve operations were excluded, as were those involving only case reports or series, letters to the editor, experimental studies, and reviews. The primary end point of the study was the odds ratio for progression to moderate to severe FTR in patients who did or did not undergo TVA. The secondary end points were the logit event rate for FTR progression in patients who had no tricuspid valve intervention as well as the mortality and tricuspid valve reoperation rate in patients who did or did not undergo TVA. The data extraction was performed independently by 3 authors (I.K., A.E., and H.S.), based on the inclusion and exclusion criteria, using the title, abstract, and full text of the studies. In case of a disagreement regarding the inclusion of a particular study, the final decision was made by the first author (I.K.). In addition, all studies to be included were subjected to a final review by the first author (I.K.) before the final decision for inclusion. The following data were extracted and recorded for each study to be included: the study design, publication year and site, patient characteristics, sample size, functional capacity of the patients, presence or absence of atrial fibrillation, the outcome in patients who did or did not undergo treatment for the alleviation of atrial fibrillation, echocardiographic data (left ventricular ejection fraction, end-systolic and end-diastolic diameters, left atrial diameter, tricuspid valve regurgitation grade), mortality, tricuspid valve reoperations, rehospitalizations due to heart failure, progression to moderate to severe FTR in the most recent follow-up after the operation, and downgrading from moderate to severe FTR. Quality assessments for each study were based on the recommendations of the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines [12Stroup D.F. Berlin J.A. Morton S.C. et al.Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.JAMA. 2000; 283: 2008-2012Crossref PubMed Scopus (15774) Google Scholar]. The total quality score was proportional to the number of criteria met and ranged between 0 and 6. For data analyses, Comprehensive Meta Analysis (CMA) 2.2.064 software (Biostat, Englewood, NJ) was used. For the analysis of all dichotomous data, odds ratios (ORs) and 95% confidence intervals (CI) were used for each independent study and statistical summary. For data analysis of all continuous data, standard mean difference, and 95% CI, were used. The full effect was analyzed with the Z test, and a p value of less than 0.05 was considered significant. The heterogeneity between the studies was tested by the Cochran Q test and I2 statistics [13Borenstein M. Hedges L. Higgins J. Rothstein H. Comprehensive meta-analysis version 2. Biostat, Engelwood, NJ2005Google Scholar, 14Higgins J.P. Thompson S.G. Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558Crossref PubMed Scopus (22314) Google Scholar]. Heterogeneity in meta-analysis refers to the variation in study outcomes between studies. The classical measure of heterogeneity is the Cochran Q, which is calculated as the weighted sum of squared differences between individual study effects and the pooled effect across studies, with the weights being those used in the pooling method. The I2 statistic describes the percentage of variation across studies that is due to heterogeneity rather than chance. I2 = 100% × (Qdf)/Q. I2 is an intuitive and simple expression of the inconsistency of studies’ results [13Borenstein M. Hedges L. Higgins J. Rothstein H. Comprehensive meta-analysis version 2. Biostat, Engelwood, NJ2005Google Scholar, 14Higgins J.P. Thompson S.G. Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558Crossref PubMed Scopus (22314) Google Scholar]. The meta-analysis was performed by the random-effects model when heterogeneity was significant, (p < 0.05, I2 > 50%) and by the fixed-effect model when it was not significant (p ≥ 0.05, I2 ≤ 50%). The results of the meta-analysis are shown as forest plots, a graphic representation that shows the effect size of all the studies and the results of the meta-analysis. The forest plot is usually accompanied by a table listing references (author and date) of the studies included in the meta-analysis. The table also lists the OR, lower and upper limit of the 95% CI, the Z value, and p value of these scores from each of the included studies. The total outcomes in each study are listed under the overall effect. The forest plot is the graph on the right-hand side. Each study in the meta-analysis is represented by a line, plotted according to the p value (it is mainly used to present the differences or ratios between two groups in a number of studies). The black diamond at the bottom of the graph shows the average effect size of the all studies [13Borenstein M. Hedges L. Higgins J. Rothstein H. Comprehensive meta-analysis version 2. Biostat, Engelwood, NJ2005Google Scholar]. The meta-analysis for the significant progression in FTR among patients who did not undergo tricuspid operations, the logit event rate, and 95% CI, were used for each independent study and the summary statistics. Meta-regression analysis was used to test the effect of several factors, such as the duration of follow-up, study quality, ethnicity, and study design on the significant FTR progression (the secondary end point). Publication bias was assessed using the Begg and Mazumdar rank correlation test and the Egger regression test [15Egger M. Davey Smith G. Schneider M. Minder C. Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634Crossref PubMed Scopus (35539) Google Scholar, 16Begg C.B. Mazumdar M. Operating characteristics of a rank correlation test for publication bias.Biometrics. 1994; 50: 1088-1101Crossref PubMed Scopus (12229) Google Scholar] and is shown using funnel graphics for the primary and secondary end points. We found 745 potentially relevant studies. Republished articles were excluded, and after evaluation of the study title and abstract, the full texts of the remaining 38 publications were reviewed for inclusion and exclusion criteria. Of these, 11 did not meet inclusion criteria, 12 were not relevant, two were reviews, and three were republished articles. Finally, 10 studies met the inclusion criteria for this meta-analysis [17Kim J.B. Yoo D.G. Kim G.S. et al.Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes.Heart. 2012; 98: 24-30Crossref PubMed Scopus (72) Google Scholar, 18Yoo J.S. Kim J.B. Jung S.H. Choo S.J. Chung C.H. Lee J.W. Impact of the maze procedure and postoperative atrial fibrillation on progression of functional tricuspid regurgitation in patients undergoing degenerative mitral repair.Eur J Cardiothorac Surg. 2013; 43: 520-525Crossref PubMed Scopus (12) Google Scholar, 19Gürsoy M. Bakuy V. Hatemi A.C. et al.Long-term prognosis of mild functional tricuspid regurgitation after mitral valve replacement.Anadolu Kardiyol Derg. 2014; 14: 34-39Crossref PubMed Scopus (1) Google Scholar, 20Smíd M. Cech J. Rokyta R. Roucka P. Hájek T. Mild to moderate functional tricuspid regurgitation: retrospective comparison of surgical and conservative treatment.Cardiol Res Pract. 2010; http://dx.doi.org/10.4061/2010/143878PubMed Google Scholar, 21Je H.G. Song H. Jung S.H. et al.Impact of the maze operation on the progression of mild functional tricuspid regurgitation.J Thorac Cardiovasc Surg. 2008; 136: 1187-1192Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 22Ro S.K. Kim J.B. Jung S.H. Choo S.J. Chung C.H. Lee J.W. Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery.J Thorac Cardiovasc Surg. 2013; 146: 1092-1097Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 23Benedetto 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: 632-638Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar, 24Shi K.H. Xuan H.Y. Zhang F. et al.Evolution of tricuspid regurgitation after mitral valve surgery for patients with moderate-or-less functional tricuspid regurgitation.Heart Surg Forum. 2012; 15: 121-126Crossref Scopus (14) Google Scholar, 25Zhu T.Y. Meng X. Han J. Li Y. Ma N. An alternative intraoperative method based on annular circumference for the decision-making of prophylactic tricuspid annuloplasty.J Heart Valve Dis. 2014; 23: 370-376PubMed Google Scholar, 26Matsuyama K. Matsumoto M. Sugita T. Nishizawa J. Tokuda Y. Matsuo T. Predictors of residual tricuspid regurgitation after mitral valve surgery.Ann Thorac Surg. 2003; 75: 1826-1828Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar]. The flow charts for the literature search and study inclusion steps are shown in Figure 1. Of these 10 studies meeting the inclusion criteria and involving a total of 2,488 patients, five studies with a control group reported the follow-up results of patients who underwent concomitant TVA for mild to moderate FTR during mitral valve operations [17Kim J.B. Yoo D.G. Kim G.S. et al.Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes.Heart. 2012; 98: 24-30Crossref PubMed Scopus (72) Google Scholar, 20Smíd M. Cech J. Rokyta R. Roucka P. Hájek T. Mild to moderate functional tricuspid regurgitation: retrospective comparison of surgical and conservative treatment.Cardiol Res Pract. 2010; http://dx.doi.org/10.4061/2010/143878PubMed Google Scholar, 22Ro S.K. Kim J.B. Jung S.H. Choo S.J. Chung C.H. Lee J.W. Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery.J Thorac Cardiovasc Surg. 2013; 146: 1092-1097Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 23Benedetto 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: 632-638Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar, 24Shi K.H. Xuan H.Y. Zhang F. et al.Evolution of tricuspid regurgitation after mitral valve surgery for patients with moderate-or-less functional tricuspid regurgitation.Heart Surg Forum. 2012; 15: 121-126Crossref Scopus (14) Google Scholar]. Four of the remaining five studies categorized patients with mild to moderate FTR who did not have a tricuspid intervention as those with or without FTR progression to document the risk factors for FTR progression [18Yoo J.S. Kim J.B. Jung S.H. Choo S.J. Chung C.H. Lee J.W. Impact of the maze procedure and postoperative atrial fibrillation on progression of functional tricuspid regurgitation in patients undergoing degenerative mitral repair.Eur J Cardiothorac Surg. 2013; 43: 520-525Crossref PubMed Scopus (12) Google Scholar, 19Gürsoy M. Bakuy V. Hatemi A.C. et al.Long-term prognosis of mild functional tricuspid regurgitation after mitral valve replacement.Anadolu Kardiyol Derg. 2014; 14: 34-39Crossref PubMed Scopus (1) Google Scholar, 25Zhu T.Y. Meng X. Han J. Li Y. Ma N. An alternative intraoperative method based on annular circumference for the decision-making of prophylactic tricuspid annuloplasty.J Heart Valve Dis. 2014; 23: 370-376PubMed Google Scholar, 26Matsuyama K. Matsumoto M. Sugita T. Nishizawa J. Tokuda Y. Matsuo T. Predictors of residual tricuspid regurgitation after mitral valve surgery.Ann Thorac Surg. 2003; 75: 1826-1828Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar], and one study reported the results of TVA and significant progression and its predictors in the nonintervention group [21Je H.G. Song H. Jung S.H. et al.Impact of the maze operation on the progression of mild functional tricuspid regurgitation.J Thorac Cardiovasc Surg. 2008; 136: 1187-1192Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar]. Seven studies [17Kim J.B. Yoo D.G. Kim G.S. et al.Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes.Heart. 2012; 98: 24-30Crossref PubMed Scopus (72) Google Scholar, 18Yoo J.S. Kim J.B. Jung S.H. Choo S.J. Chung C.H. Lee J.W. Impact of the maze procedure and postoperative atrial fibrillation on progression of functional tricuspid regurgitation in patients undergoing degenerative mitral repair.Eur J Cardiothorac Surg. 2013; 43: 520-525Crossref PubMed Scopus (12) Google Scholar, 19Gürsoy M. Bakuy V. Hatemi A.C. et al.Long-term prognosis of mild functional tricuspid regurgitation after mitral valve replacement.Anadolu Kardiyol Derg. 2014; 14: 34-39Crossref PubMed Scopus (1) Google Scholar, 20Smíd M. Cech J. Rokyta R. Roucka P. Hájek T. Mild to moderate functional tricuspid regurgitation: retrospective comparison of surgical and conservative treatment.Cardiol Res Pract. 2010; http://dx.doi.org/10.4061/2010/143878PubMed Google Scholar, 21Je H.G. Song H. Jung S.H. et al.Impact of the maze operation on the progression of mild functional tricuspid regurgitation.J Thorac Cardiovasc Surg. 2008; 136: 1187-1192Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 22Ro S.K. Kim J.B. Jung S.H. Choo S.J. Chung C.H. Lee J.W. Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery.J Thorac Cardiovasc Surg. 2013; 146: 1092-1097Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 26Matsuyama K. Matsumoto M. Sugita T. Nishizawa J. Tokuda Y. Matsuo T. Predictors of residual tricuspid regurgitation after mitral valve surgery.Ann Thorac Surg. 2003; 75: 1826-1828Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar] were retrospective, two were randomized controlled studies [23Benedetto 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: 632-638Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar, 24Shi K.H. Xuan H.Y. Zhang F. et al.Evolution of tricuspid regurgitation after mitral valve surgery for patients with moderate-or-less functional tricuspid regurgitation.Heart Surg Forum. 2012; 15: 121-126Crossref Scopus (14) Google Scholar], and one was a prospective study [25Zhu T.Y. Meng X. Han J. Li Y. Ma N. An alternative intraoperative method based on annular circumference for the decision-making of prophylactic tricuspid annuloplasty.J Heart Valve Dis. 2014; 23: 370-376PubMed Google Scholar]. The demographic characteristics of study participants in all studies included in the meta-analysis are reported in Table 1. In six studies [17Kim J.B. Yoo D.G. Kim G.S. et al.Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes.Heart. 2012; 98: 24-30Crossref PubMed Scopus (72) Google Scholar, 20Smíd M. Cech J. Rokyta R. Roucka P. Hájek T. Mild to moderate functional tricuspid regurgitation: retrospective comparison of surgical and conservative treatment.Cardiol Res Pract. 2010; http://dx.doi.org/10.4061/2010/143878PubMed Google Scholar, 21Je H.G. Song H. Jung S.H. et al.Impact of the maze operation on the progression of mild functional tricuspid regurgitation.J Thorac Cardiovasc Surg. 2008; 136: 1187-1192Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 22Ro S.K. Kim J.B. Jung S.H. Choo S.J. Chung C.H. Lee J.W. Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery.J Thorac Cardiovasc Surg. 2013; 146: 1092-1097Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 23Benedetto 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: 632-638Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar, 24Shi K.H. Xuan H.Y. Zhang F. et al.Evolution of tricuspid regurgitation after mitral valve surgery for patients with moderate-or-less functional tricuspid regurgitation.Heart Surg Forum. 2012; 15: 121-126Crossref Scopus (14) Google Scholar] reporting the clinical outcomes in 1,641 patients (773 patients TVA vs 868 patients with no TVA), 57 patients had early (<1 year) [20Smíd M. Cech J. Rokyta R. Roucka P. Hájek T. Mild to moderate functional tricuspid regurgitation: retrospective comparison of surgical and conservative treatment.Cardiol Res Pract. 2010; http://dx.doi.org/10.4061/2010/143878PubMed Google Scholar], 280 had intermediate (≥1 year and <5 years) [17Kim J.B. Yoo D.G. Kim G.S. et al.Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes.Heart. 2012; 98: 24-30Crossref PubMed Scopus (72) Google Scholar, 23Benedetto 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: 632-638Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar], and 1,294 patients had long-term (≥5 years) [21Je H.G. Song H. Jung S.H. et al.Impact of the maze operation on the progression of mild functional tricuspid regurgitation.J Thorac Cardiovasc Surg. 2008; 136: 1187-1192Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar, 22Ro S.K. Kim J.B. Jung S.H. Choo S.J. Chung C.H. Lee J.W. Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery.J Thorac Cardiovasc Surg. 2013; 146: 1092-1097Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 24Shi K.H. Xuan H.Y. Zhang F. et al.Evolution of tricuspid regurgitation after mitral valve surgery for patients with moderate-or-less functional tricuspid regurgitation.Heart Surg Forum. 2012; 15: 121-126Crossref Scopus (14) Google Scholar] results reported. Also, the echocardiographic FTR progression rate (range, 3 to 100.8 months) was reported for 1,711 patients with mild to moderate FTR at baseline who had no tricuspid intervention (short-term, intermediate-term, and long-term results were reported in 1, 4, and 5 studies, respectively).Table 1Characteristics of the Studies Included in the Meta-AnalysisFirst AuthorYearStudy DesignStudy Size (No.)LocationTVA (No.)No TVA (No.)FTR Progression (No.)Follow-Up (mo)Kim 17Kim J.B. Yoo D.G. Kim G.S. et al.Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes.Heart. 2012; 98: 24-30Crossref PubMed Scopus (72) Google Scholar2012RS236Korea1231136/123; 28/11348.7Yoo 18Yoo J.S. Kim J.B. Jung S.H. Choo S.J. Chung C.H. Lee J.W. Impact of the maze procedure and postoperative atrial fibrillation on progression of functional tricuspid regurgitation in patients undergoing degenerative mitral repair.Eur J Cardiothorac Surg. 2013; 43: 520-525Crossref PubMed Scopus (12) Google Scholar2013RS398Korea…3981648.3Gürsoy 19Gürsoy M. Bakuy V. Hatemi A.C. et al.Long-term prognosis of mild functional tricuspid regurgitation after mitral valve replacement.Anadolu Kardiyol Derg. 2014; 14: 34-39Crossref PubMed Scopus (1) Google Scholar2014RS66Turkey…6634/66100.8Smíd 20Smíd M. Cech J. Rokyta R. Roucka P. Hájek T. Mild to moderate functional tricuspid regurgitation: retrospective comparison of surgical and conservative treatment.Cardiol Res Pract. 2010; http://dx.doi.org/10.4061/2010/143878PubMed Google Scholar2010RS67Czech45420/45; 7/423Je 21Je H.G. Song H. Jung S.H. et al.Impact of the maze operation on the progression of mild functional tricuspid regurgitation.J Thorac Cardiovasc Surg. 2008; 136: 1187-1192Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar2008RS250Korea…25041/25062.7Ro 22Ro S.K. Kim J.B. Jung S.H. Choo S.J. Chung C.H. Lee J.W. Mild-to-moderate functional tricuspid regurgitation in patients undergoing mitral valve surgery.J Thorac Cardiovasc Surg. 2013; 146: 1092-1097Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar2013RS959Korea43152815/144aGroups after adjustment for baseline characteristics by propensity score.; 20/144aGroups after adjustment for baseline characteristics by propensity score.64.8Benedetto 23Benedetto 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: 632-638Abstract Full Text Full Text PDF PubMed Scopus (158) Google Scholar2012RCT44Italy22220/22; 6/2212Shi 24Shi K.H. Xuan H.Y. Zhang F. et al.Evolution of tricuspid regurgitation after mitral valve surgery for patients with moderate-or-less functional tricuspid regurgitation.Heart Surg Forum. 2012; 15: 121-126Crossref Scopus (14) Google Scholar2012RCT167China709712/53; 24/4963Zhu 25Zhu T.Y. Meng X. Han J. Li Y. Ma N. An alternative intraoperative method based on annular circumference for the decision-making of prophylactic tricuspid annuloplasty.J Heart Valve Dis. 2014; 23: 370-376PubMed Google Scholar2014PS127China…12723/12330.2Matsuyama 26Matsuyama K. Matsumoto M. Sugita T. Nishizawa J. Tokuda Y. Matsuo T. Predictors of residual tricuspid regurgitation after mitral valve surgery.Ann Thorac Surg. 2003; 75: 1826-1828Abstract Full Text Full Text PDF PubMed Scopus (195) Google Scholar2003RS174Japan…1
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