Abstract
Background: Untreated tricuspid regurgitation during mitral valve surgery may
progress to severe symptomatic tricuspid regurgitation. Concomitant repair may
increase the operative risk; however, re-operative tricuspid valve surgery is a highrisk procedure. This study's objective was to identify the predictors of DeVega repair
failure in patients with functional tricuspid regurgitation and concomitant mitral
valve surgery.
Methods: This research is a retrospective comparative study that included 140
patients who underwent tricuspid valve repair concomitant with mitral valve
replacement. We divided the patients into two groups; the first group (n=106)
included patients with no DeVega failure at six-months follow-up (The sustained
repair group). The second group included 34 patients who developed moderate or
higher TR after the DeVega and was named the failed repair group.
Results: The demographic data and comorbidities were not statistically different
between both groups. The preoperative atrial fibrillation (73 (69%) vs. 30 (88%)’ p=
0.027) pulmonary artery pressure (64.8±3.6 vs. 81±6.5 mmHg; p= 0.02), right
ventricular dimension (4.85±0.24 vs. 5.23±0.37 cm; p= 0.03), and time between the
indication of surgery and operation (8.3 ± 3.1 vs. 14.7 ± 5.4 months; p = 0.003) were
higher in patients with failed DeVega repair. There was no statistically significant
difference regarding the mean bypass time, cross-clamp time, ICU and hospital stay,
and postoperative complications between both groups. Predictors of failure after six
months were preoperative heart failure (OR: 15.4 (95% CI: 3- 92.3); p= 0.003), long
time between diagnosis and surgery (OR: 12.3 (95% CI: 2.1- 84.7); p= 0.007), and
postoperative severe pulmonary hypertension (OR: 24.7 (95% CI: 3.1- 199.6); p=
0.003).
Conclusions: DeVega repair is associated with a high failure rate after six months.
The study of predictors of failure could change our management plans to reach the
best results for repair. |
