Percutaneous mitral valvuloplasty versus surgical treatment in mitral stenosis with severe tricuspid regurgitation

Hyun Song, Duk Hyun Kang, Jeong Hoon Kim, Kyoung Min Park, Jong Min Song, Kee Joon Choi, Myeongki Hong, Cheol Hyun Chung, Jae Kwan Song, Jae Won Lee, Seong Wook Park, Seung Jung Park

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

BACKGROUND - The persistence of significant tricuspid regurgitation (TR) after percutaneous mitral valvuloplasty (PMV) is known to be an independent predictor of adverse outcome in mitral stenosis (MS). However, it remains unclear whether mitral valve (MV) surgery combined with surgical correction of TR is the better treatment option than PMV in patients with severe MS and severe functional TR. METHODS AND RESULTS - We included a total of 92 consecutive patients (18 men, age 49±13 years) with severe MS and severe functional TR, who were potential candidates for PMV from 1997 to 2005, and the exclusion criteria were defined as the presence of left atrial thrombi, mitral regurgitation ≥grade 3, echo score >10, and left ventricular ejection fraction (EF) <35%. PMV was performed on 48 patients (PMV group), and MV surgery combined with tricuspid valve (TV) repair was performed on 44 patients (TVP group). The clinical events were defined as death, repeat surgical or percutaneous intervention, and readmission because of heart failure. There were no significant differences between the 2 groups in terms of gender, baseline EF, and baseline severity of pulmonary hypertension, but patients in the TVP group were older and had a higher echo score and a higher incidence of atrial fibrillation than those in the PMV group. During follow-up of 57±35 months, 2 deaths occurred in the TVP group, and there were 2 deaths, 7 cases of heart failure requiring surgical intervention in the PMV group. The difference of event rates between the 2 groups showed borderline significance (P=0.05), but no difference in mortality was observed. The estimated actuarial 7-year event-free survival rate was 77±8% in the PMV group and 95±3% in the TVP group. Severe TR was improved to mild or absent TR in 43 (98%) patients in the TVP group, and this was significantly higher than in the PMV group (22/48, 46%; P<0.001). In the TVP group, the right ventricle (RV) size was significantly decreased in 18 (90%) patients among 20 patients with preoperative significant RV enlargement. On stepwise multivariate logistic regression analysis, TVP group and baseline sinus rhythm were independent predictors for improvement of TR (P<0.001). CONCLUSIONS - TV repair combined with MV surgery was related to better clinical outcomes than PMV alone, and we recommend that this surgical option should be considered preferentially in severe MS with severe functional TR, especially if atrial fibrillation or enlarged RV is associated.

Original languageEnglish
JournalCirculation
Volume116
Issue number11 SUPPL. 1
DOIs
Publication statusPublished - 2007 Sep 1

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Tricuspid Valve Insufficiency
Mitral Valve Stenosis
Mitral Valve
Heart Ventricles
Tricuspid Valve
Therapeutics
Atrial Fibrillation
Heart Failure
Mitral Valve Insufficiency
Pulmonary Hypertension
Stroke Volume
Disease-Free Survival
Thrombosis
Survival Rate
Logistic Models
Regression Analysis
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Song, H., Kang, D. H., Kim, J. H., Park, K. M., Song, J. M., Choi, K. J., ... Park, S. J. (2007). Percutaneous mitral valvuloplasty versus surgical treatment in mitral stenosis with severe tricuspid regurgitation. Circulation, 116(11 SUPPL. 1). https://doi.org/10.1161/CIRCULATIONAHA.107.678151
Song, Hyun ; Kang, Duk Hyun ; Kim, Jeong Hoon ; Park, Kyoung Min ; Song, Jong Min ; Choi, Kee Joon ; Hong, Myeongki ; Chung, Cheol Hyun ; Song, Jae Kwan ; Lee, Jae Won ; Park, Seong Wook ; Park, Seung Jung. / Percutaneous mitral valvuloplasty versus surgical treatment in mitral stenosis with severe tricuspid regurgitation. In: Circulation. 2007 ; Vol. 116, No. 11 SUPPL. 1.
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title = "Percutaneous mitral valvuloplasty versus surgical treatment in mitral stenosis with severe tricuspid regurgitation",
abstract = "BACKGROUND - The persistence of significant tricuspid regurgitation (TR) after percutaneous mitral valvuloplasty (PMV) is known to be an independent predictor of adverse outcome in mitral stenosis (MS). However, it remains unclear whether mitral valve (MV) surgery combined with surgical correction of TR is the better treatment option than PMV in patients with severe MS and severe functional TR. METHODS AND RESULTS - We included a total of 92 consecutive patients (18 men, age 49±13 years) with severe MS and severe functional TR, who were potential candidates for PMV from 1997 to 2005, and the exclusion criteria were defined as the presence of left atrial thrombi, mitral regurgitation ≥grade 3, echo score >10, and left ventricular ejection fraction (EF) <35{\%}. PMV was performed on 48 patients (PMV group), and MV surgery combined with tricuspid valve (TV) repair was performed on 44 patients (TVP group). The clinical events were defined as death, repeat surgical or percutaneous intervention, and readmission because of heart failure. There were no significant differences between the 2 groups in terms of gender, baseline EF, and baseline severity of pulmonary hypertension, but patients in the TVP group were older and had a higher echo score and a higher incidence of atrial fibrillation than those in the PMV group. During follow-up of 57±35 months, 2 deaths occurred in the TVP group, and there were 2 deaths, 7 cases of heart failure requiring surgical intervention in the PMV group. The difference of event rates between the 2 groups showed borderline significance (P=0.05), but no difference in mortality was observed. The estimated actuarial 7-year event-free survival rate was 77±8{\%} in the PMV group and 95±3{\%} in the TVP group. Severe TR was improved to mild or absent TR in 43 (98{\%}) patients in the TVP group, and this was significantly higher than in the PMV group (22/48, 46{\%}; P<0.001). In the TVP group, the right ventricle (RV) size was significantly decreased in 18 (90{\%}) patients among 20 patients with preoperative significant RV enlargement. On stepwise multivariate logistic regression analysis, TVP group and baseline sinus rhythm were independent predictors for improvement of TR (P<0.001). CONCLUSIONS - TV repair combined with MV surgery was related to better clinical outcomes than PMV alone, and we recommend that this surgical option should be considered preferentially in severe MS with severe functional TR, especially if atrial fibrillation or enlarged RV is associated.",
author = "Hyun Song and Kang, {Duk Hyun} and Kim, {Jeong Hoon} and Park, {Kyoung Min} and Song, {Jong Min} and Choi, {Kee Joon} and Myeongki Hong and Chung, {Cheol Hyun} and Song, {Jae Kwan} and Lee, {Jae Won} and Park, {Seong Wook} and Park, {Seung Jung}",
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language = "English",
volume = "116",
journal = "Circulation",
issn = "0009-7322",
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Song, H, Kang, DH, Kim, JH, Park, KM, Song, JM, Choi, KJ, Hong, M, Chung, CH, Song, JK, Lee, JW, Park, SW & Park, SJ 2007, 'Percutaneous mitral valvuloplasty versus surgical treatment in mitral stenosis with severe tricuspid regurgitation', Circulation, vol. 116, no. 11 SUPPL. 1. https://doi.org/10.1161/CIRCULATIONAHA.107.678151

Percutaneous mitral valvuloplasty versus surgical treatment in mitral stenosis with severe tricuspid regurgitation. / Song, Hyun; Kang, Duk Hyun; Kim, Jeong Hoon; Park, Kyoung Min; Song, Jong Min; Choi, Kee Joon; Hong, Myeongki; Chung, Cheol Hyun; Song, Jae Kwan; Lee, Jae Won; Park, Seong Wook; Park, Seung Jung.

In: Circulation, Vol. 116, No. 11 SUPPL. 1, 01.09.2007.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Percutaneous mitral valvuloplasty versus surgical treatment in mitral stenosis with severe tricuspid regurgitation

AU - Song, Hyun

AU - Kang, Duk Hyun

AU - Kim, Jeong Hoon

AU - Park, Kyoung Min

AU - Song, Jong Min

AU - Choi, Kee Joon

AU - Hong, Myeongki

AU - Chung, Cheol Hyun

AU - Song, Jae Kwan

AU - Lee, Jae Won

AU - Park, Seong Wook

AU - Park, Seung Jung

PY - 2007/9/1

Y1 - 2007/9/1

N2 - BACKGROUND - The persistence of significant tricuspid regurgitation (TR) after percutaneous mitral valvuloplasty (PMV) is known to be an independent predictor of adverse outcome in mitral stenosis (MS). However, it remains unclear whether mitral valve (MV) surgery combined with surgical correction of TR is the better treatment option than PMV in patients with severe MS and severe functional TR. METHODS AND RESULTS - We included a total of 92 consecutive patients (18 men, age 49±13 years) with severe MS and severe functional TR, who were potential candidates for PMV from 1997 to 2005, and the exclusion criteria were defined as the presence of left atrial thrombi, mitral regurgitation ≥grade 3, echo score >10, and left ventricular ejection fraction (EF) <35%. PMV was performed on 48 patients (PMV group), and MV surgery combined with tricuspid valve (TV) repair was performed on 44 patients (TVP group). The clinical events were defined as death, repeat surgical or percutaneous intervention, and readmission because of heart failure. There were no significant differences between the 2 groups in terms of gender, baseline EF, and baseline severity of pulmonary hypertension, but patients in the TVP group were older and had a higher echo score and a higher incidence of atrial fibrillation than those in the PMV group. During follow-up of 57±35 months, 2 deaths occurred in the TVP group, and there were 2 deaths, 7 cases of heart failure requiring surgical intervention in the PMV group. The difference of event rates between the 2 groups showed borderline significance (P=0.05), but no difference in mortality was observed. The estimated actuarial 7-year event-free survival rate was 77±8% in the PMV group and 95±3% in the TVP group. Severe TR was improved to mild or absent TR in 43 (98%) patients in the TVP group, and this was significantly higher than in the PMV group (22/48, 46%; P<0.001). In the TVP group, the right ventricle (RV) size was significantly decreased in 18 (90%) patients among 20 patients with preoperative significant RV enlargement. On stepwise multivariate logistic regression analysis, TVP group and baseline sinus rhythm were independent predictors for improvement of TR (P<0.001). CONCLUSIONS - TV repair combined with MV surgery was related to better clinical outcomes than PMV alone, and we recommend that this surgical option should be considered preferentially in severe MS with severe functional TR, especially if atrial fibrillation or enlarged RV is associated.

AB - BACKGROUND - The persistence of significant tricuspid regurgitation (TR) after percutaneous mitral valvuloplasty (PMV) is known to be an independent predictor of adverse outcome in mitral stenosis (MS). However, it remains unclear whether mitral valve (MV) surgery combined with surgical correction of TR is the better treatment option than PMV in patients with severe MS and severe functional TR. METHODS AND RESULTS - We included a total of 92 consecutive patients (18 men, age 49±13 years) with severe MS and severe functional TR, who were potential candidates for PMV from 1997 to 2005, and the exclusion criteria were defined as the presence of left atrial thrombi, mitral regurgitation ≥grade 3, echo score >10, and left ventricular ejection fraction (EF) <35%. PMV was performed on 48 patients (PMV group), and MV surgery combined with tricuspid valve (TV) repair was performed on 44 patients (TVP group). The clinical events were defined as death, repeat surgical or percutaneous intervention, and readmission because of heart failure. There were no significant differences between the 2 groups in terms of gender, baseline EF, and baseline severity of pulmonary hypertension, but patients in the TVP group were older and had a higher echo score and a higher incidence of atrial fibrillation than those in the PMV group. During follow-up of 57±35 months, 2 deaths occurred in the TVP group, and there were 2 deaths, 7 cases of heart failure requiring surgical intervention in the PMV group. The difference of event rates between the 2 groups showed borderline significance (P=0.05), but no difference in mortality was observed. The estimated actuarial 7-year event-free survival rate was 77±8% in the PMV group and 95±3% in the TVP group. Severe TR was improved to mild or absent TR in 43 (98%) patients in the TVP group, and this was significantly higher than in the PMV group (22/48, 46%; P<0.001). In the TVP group, the right ventricle (RV) size was significantly decreased in 18 (90%) patients among 20 patients with preoperative significant RV enlargement. On stepwise multivariate logistic regression analysis, TVP group and baseline sinus rhythm were independent predictors for improvement of TR (P<0.001). CONCLUSIONS - TV repair combined with MV surgery was related to better clinical outcomes than PMV alone, and we recommend that this surgical option should be considered preferentially in severe MS with severe functional TR, especially if atrial fibrillation or enlarged RV is associated.

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