{"id":"5c196ecfb26f","type":"article","url":"https://hartvaat.nl/2021/02/16/progressie-van-tricuspidalisinsufficientie-na-chirurgie-voor-ischemische-mr/","title":"Progressie van tricuspidalisinsufficiëntie na chirurgie voor ischemische MR","title_en":"Progression of Tricuspid Regurgitation After Surgery for Ischemic Mitral Regurgitation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["tricuspidalisinsufficiëntie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.11.066","source_url":"https://doi.org/10.1016/j.jacc.2020.11.066","authors":["Philippe B Bertrand","Jessica R Overbey","Xin Zeng","Robert A Levine","Gorav Ailawadi","Michael A Acker","Peter K Smith","Vinod H Thourani","Emilia Bagiella","Marissa A Miller","Lopa Gupta","Michael J Mack","A Marc Gillinov","Gennaro Giustino","Alan J Moskowitz","Annetine C Gelijns","Michael E Bowdish","Patrick T O'Gara","James S Gammie","Judy Hung"],"significance":5,"published":"2021-02-16","source_date":"2021-02-16","image":"","kennis":[],"congress":"","summary_en":"This analysis documented the progression of tricuspid regurgitation after surgery for ischemic mitral regurgitation, informing the debate about concomitant tricuspid repair during mitral valve operations.","created":"2026-07-03T10:29:04Z","updated":"2026-07-03T13:28:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van progressie van tricuspidalisinsufficiëntie na chirurgie voor ischemische mitralisklepinsufficiëntie.","abstract_original":"BACKGROUND: Whether to repair nonsevere tricuspid regurgitation (TR) during surgery for ischemic mitral valve regurgitation (IMR) remains uncertain. OBJECTIVES: The goal of this study was to investigate the incidence, predictors, and clinical significance of TR progression and presence of ≥moderate TR after IMR surgery. METHODS: Patients (n = 492) with untreated nonsevere TR within 2 prospectively randomized IMR trials were included. Key outcomes were TR progression (either progression by ≥2 grades, surgery for TR, or severe TR at 2 years) and presence of ≥moderate TR at 2 years. RESULTS: Patients' mean age was 66 ± 10 years (67% male), and TR distribution was 60% ≤trace, 31% mild, and 9% moderate. Among 2-year survivors, TR progression occurred in 20 (6%) of 325 patients. Baseline tricuspid annular diameter (TAD) was not predictive of TR progression. At 2 years, 37 (11%) of 323 patients had ≥moderate TR. Baseline TR grade, indexed TAD, and surgical ablation for atrial fibrillation were independent predictors of ≥moderate TR. However, TAD alone had poor discrimination (area under the curve, ≤0.65). Presence of ≥moderate TR at 2 years was higher in patients with MR recurrence (20% vs. 9%; p = 0.02) and a permanent pacemaker/defibrillator (19% vs. 9%; p = 0.01). Clinical event rates (composite of ≥1 New York Heart Association functional class increase, heart failure hospitalization, mitral valve surgery, and stroke) were higher in patients with TR progression (55% vs. 23%; p = 0.003) and ≥moderate TR at 2 years (38% vs. 22%; p = 0.04). CONCLUSIONS: After IMR surgery, progression of unrepaired nonsevere TR is uncommon. Baseline TAD is not predictive of TR progression and is poorly discriminative of ≥moderate TR at 2 years. TR progression and presence of ≥moderate TR are associated with clinical events. (Comparing the Effectiveness of a Mitral Valve Repair Procedure in Combination With Coronary Artery Bypass Grafting [CABG] Versus CABG Alone in People With Moderate Ischemic Mitral Regurgitation, NCT00806988; Comparing the Effectiveness of Repairing Versus Replacing the Heart's Mitral Valve in People With Severe Chronic Ischemic Mitral Regurgitation, NCT00807040)."}