Studies on the management of functional tricuspid regurgitation (TR) during mitral valve operations have drawn inconsistent conclusions. This study was designed to compare the treatment strategy of concomitant tricuspid annuloplasty (TAP) against isolated mitral valve replacement (MVR) in rheumatic mitral valve disease patients, and to assess the effect of concomitant TAP on postoperative right ventricular (RV) remodeling and function. One hundred-seventy patients with rheumatic mitral valve disease receiving MVR were categorized into TAP group (n = 124) and non-TAP group (n = 46). Clinical and echocardiographic data were collected preoperatively and at 1-year follow-up. Three-dimensional echocardiographic indices of RV geometry and function were analyzed. At baseline, concomitant TAP group had larger RV end-diastolic volume, more decreased RV ejection fraction and RV longitudinal strain than non-TAP group (all P < 0.001). At 1-year follow-up, TAP group had improved RV geometry and function. While adverse changes were observed in non-TAP group. In analysis of variance, the above indices demonstrated significant interaction with different treatment group (all P < 0.001). In multivariate regression analysis, independent of age and Maze procedure, concomitant TAP was associated with postoperative RV volume reduction (P < 0.001), improvement of RV ejection fraction (P < 0.001), and relieved postoperative functional TR severity (P = 0.025). Our results suggest that concomitant TAP could improve RV remodeling and function for rheumatic mitral valve disease patients, while those with mild preoperative functional TR who had isolated MVR might experience RV dilation and deterioration of RV function at follow-up. Concomitant surgery for functional TR could be considered for patients undergoing MVR with rheumatic mitral valve disease.

中文翻译：

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三尖瓣瓣环成形术对风湿性二尖瓣疾病患者右心室重构的影响

关于二尖瓣手术期间功能性三尖瓣关闭不全 (TR) 管理的研究得出了不一致的结论。本研究旨在比较风湿性二尖瓣疾病患者中伴随三尖瓣瓣环成形术 (TAP) 与孤立二尖瓣置换术 (MVR) 的治疗策略，并评估伴随 TAP 对术后右心室 (RV) 重构和功能的影响。170 名接受 MVR 的风湿性二尖瓣疾病患者分为 TAP 组（n = 124）和非 TAP 组（n = 46）。在术前和 1 年随访时收集临床和超声心动图数据。分析了 RV 几何形状和功能的三维超声心动图指数。在基线时，伴随的 TAP 组有较大的 RV 舒张末期容积，与非 TAP 组相比，RV 射血分数和 RV 纵向应变降低更多（所有 P < 0.001）。在 1 年的随访中，TAP 组改善了 RV 几何形状和功能。而在非 TAP 组中观察到不利变化。在方差分析中，上述指标与不同治疗组之间存在显着的交互作用（均 P < 0.001）。在多元回归分析中，与年龄和迷宫手术无关，伴随的 TAP 与术后 RV 体积减少（P < 0.001）、RV 射血分数改善（P < 0.001）和术后功能性 TR 严重程度减轻（P = 0.025）相关。我们的结果表明伴随 TAP 可以改善风湿性二尖瓣疾病患者的 RV 重构和功能，而那些有轻度术前功能性 TR 且孤立 MVR 的患者可能会在随访时经历 RV 扩张和 RV 功能恶化。对于接受 MVR 的风湿性二尖瓣疾病患者，可考虑同时进行功能性 TR 手术。