Mitral valve surgery for functional mitral regurgitation. Should moderate-or-more tricuspid regurgitation be treated? A propensity score analysis
Antonio M. Calafiore1, Sabina Gallina2, Angela L. Iaco'1, Marco Contini1, Antonio Bivona1, Massimo Gagliardi1, Paolo Bosco1, Michele Di Mauro1; 1Cardiac Surgery, University of Catania, Catania, Italy; 2University of Chieti-Dept of Cardiology, Chieti, Italy
Comment on this Abstract
Objective: The aim of this retrospective study was to evaluate the clinical outcome of treating/untreated moderate-or-more functional tricuspid regurgitation (FTR) in patients with functional mitral regurgitation (FMR) undergoing mitral valve surgery (MVS).
Methods: From January 1988 to March 2003, 110 patients with FMR undergoing MVS showed moderate-or-more FTR, which was treated (group T) in 51 and untreated in 59 (group UT) cases. A non-parsimonious regression model (c-statistic=0.83, bootstrapping=500 samples) was built to obtain the propensity score. The latter was used by means of a sample matching to select a cohort of 100 patients (50 group T and 50 group UT). The two groups were similar for all evaluated preoperative and operative variables, but tricuspid valve annulus (21.4±2.3mm/m2 group UT vs 25.1±2.3mm/m2 group T, p<0.001). Tricuspid valve was always repaired using DeVega technique. Mitral valve was repaired in 75 and replaced in 25 cases; no residual moderate-or-more FMR was assessed at hospital discharge. Impact of untreated moderate-or-more FTR was estimated by Cox analysis. The results were reported as regression coefficient(b)±standard error(SE) and p-value. The final model was validated in 500 bootstrap samples.
Results: Thirty-day mortality was 6.0% (10% group UT vs 2% group T, p=0.204). Five-year survival was 53.0±5.0 (36.0±6.8 group UT vs 70.0±6.5 group T, p<0.001); The possibility to be alive in I-II NYHA class was 40.6±4.9 (34.6±4.9 group UT vs 66.8±7.1 group T, p<0.001). Untreated moderate-or-more FTR resulted a risk factor for worse midterm survival (b±SE=2.5±0.5, p<0.001) and the possibility to be alive in I-II NYHA class (b±SE=2.2±0.5,p<0.001)
Conclusion: Tricuspid annuloplasty is an easy and safe procedure, mandatory in case of at least moderate FTR to achieve better mid-term outcome in patients with functional mitral regurgitation undergoing mitral valve surgery.
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