Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation
| Autor: | Michael A. Borger, Alan J Moskowitz, Friedhelm Beyersdorf, Steven F. Bolling, Lenard Conradi, Michael E Bowdish, Judy Hung, Pierre Voisine, Jessica Overbey, Eric A. Rose, John C. Mullen, Samantha Raymond, Annetine C. Gelijns, Neal Jeffries, Mariell Jessup, Karen O'Sullivan, Marissa A. Miller, James S. Gammie, Alexander Iribarne, Mary E. Marks, Arnar Geirsson, Michael J Mack, Ctsn Investigators, Babatunde Yerokun, Ellen Moquete, Emilia Bagiella, Richard D. Weisel, Marc Gillinov, Volkmar Falk, Markus Krane, Gorav Ailawadi, Patrick T. O'Gara, Michael W A Chu, Michael K. Parides, Wendy C. Taddei-Peters |
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| Rok vydání: | 2023 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Pacemaker Artificial macromolecular substances Cardiac Valve Annuloplasty Postoperative Complications Internal medicine medicine Humans In patient cardiovascular diseases Aged Mitral regurgitation business.industry Mitral Valve Insufficiency General Medicine Survival Analysis Tricuspid Valve Insufficiency Intention to Treat Analysis Concomitant Regurgitation (digestion) cardiovascular system Cardiology Disease Progression Quality of Life Mitral Valve Female Tricuspid Valve medicine.symptom business Dilatation Pathologic Follow-Up Studies |
| Zdroj: | The New England journal of medicine. 386(4) |
| ISSN: | 1533-4406 |
| Popis: | Tricuspid regurgitation is common in patients with severe degenerative mitral regurgitation. However, the evidence base is insufficient to inform a decision about whether to perform tricuspid-valve repair during mitral-valve surgery in patients who have moderate tricuspid regurgitation or less-than-moderate regurgitation with annular dilatation.We randomly assigned 401 patients who were undergoing mitral-valve surgery for degenerative mitral regurgitation to receive a procedure with or without tricuspid annuloplasty (TA). The primary 2-year end point was a composite of reoperation for tricuspid regurgitation, progression of tricuspid regurgitation by two grades from baseline or the presence of severe tricuspid regurgitation, or death.Patients who underwent mitral-valve surgery plus TA had fewer primary-end-point events than those who underwent mitral-valve surgery alone (3.9% vs. 10.2%) (relative risk, 0.37; 95% confidence interval [CI], 0.16 to 0.86; P = 0.02). Two-year mortality was 3.2% in the surgery-plus-TA group and 4.5% in the surgery-alone group (relative risk, 0.69; 95% CI, 0.25 to 1.88). The 2-year prevalence of progression of tricuspid regurgitation was lower in the surgery-plus-TA group than in the surgery-alone group (0.6% vs. 6.1%; relative risk, 0.09; 95% CI, 0.01 to 0.69). The frequencies of major adverse cardiac and cerebrovascular events, functional status, and quality of life were similar in the two groups at 2 years, although the incidence of permanent pacemaker implantation was higher in the surgery-plus-TA group than in the surgery-alone group (14.1% vs. 2.5%; rate ratio, 5.75; 95% CI, 2.27 to 14.60).Among patients undergoing mitral-valve surgery, those who also received TA had a lower incidence of a primary-end-point event than those who underwent mitral-valve surgery alone at 2 years, a reduction that was driven by less frequent progression to severe tricuspid regurgitation. Tricuspid repair resulted in more frequent permanent pacemaker implantation. Whether reduced progression of tricuspid regurgitation results in long-term clinical benefit can be determined only with longer follow-up. (Funded by the National Heart, Lung, and Blood Institute and the German Center for Cardiovascular Research; ClinicalTrials.gov number, NCT02675244.). |
| Databáze: | OpenAIRE |
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