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Morphological diversity of the tricuspid posterior leaflet affects surgical complexity for control of tricuspid regurgitation
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  • takumi kawase,
  • Yosuke Takahashi,
  • Kenta Nishiya,
  • Noriaki Kishimoto,
  • Kokoro Yamane,
  • Yoshito Sakon,
  • Akimasa Morisaki,
  • Hiromichi Fujii,
  • Toshihiko Shibata
takumi kawase
Osaka City University Graduate School of Medicine School of Medicine
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Yosuke Takahashi
Osaka City University Graduate School of Medicine School of Medicine
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Kenta Nishiya
Osaka City University Graduate School of Medicine School of Medicine
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Noriaki Kishimoto
Osaka City University Graduate School of Medicine School of Medicine
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Kokoro Yamane
Osaka City University Graduate School of Medicine School of Medicine
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Yoshito Sakon
Osaka City University Graduate School of Medicine School of Medicine
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Akimasa Morisaki
Osaka City University Graduate School of Medicine School of Medicine
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Hiromichi Fujii
Osaka City University Graduate School of Medicine School of Medicine
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Toshihiko Shibata
Osaka City University Graduate School of Medicine School of Medicine
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Abstract

Abstract Objective: We investigated the effect of morphological diversity of the tricuspid valve with multiple posterior leaflets on the technical outcomes of tricuspid valve repair. Methods: From April 2016 to November 2020, 141 patients were diagnosed with secondary tricuspid regurgitation associated with left heart disease and underwent tricuspid valve repair. We retrospectively analyzed the clinical and echocardiographic data of patients who underwent both preoperative and postoperative transthoracic echocardiography. We divided the patients into two groups according to the surgical technique used to treat tricuspid regurgitation: ring annuloplasty alone (Group 1, n=109) or additional approximation of leaflet edges (edge-to-edge repair) with ring annuloplasty (Group 2, n=32). We measured the morphological diversity of the tricuspid valve during the operation in all patients. Results: The preoperative tricuspid regurgitation score was higher in Group 2 than in Group 1 (2.1±0.78 vs. 1.6±0.7, respectively; p=0.0046), and Group 2 contained more patients with two posterior leaflets than Group 1 [20 (63%) vs. 36 (33%), respectively; p=0.003]. The univariate and multivariate logistic regression analyses showed that the presence of two posterior leaflets was an independent risk factor for additional procedures during tricuspid valve repair (odds ratio, 2.6; 95% confidence interval, 1.1–6.1; p=0.033). Conclusions: Additional procedures to reduce tricuspid regurgitation were required more frequently in patients with two posterior leaflets of the tricuspid valve. The morphological diversity of two posterior leaflets is a potential risk factor for a more complicated tricuspid repair.