{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T05:18:28Z","timestamp":1784438308915,"version":"3.55.0"},"reference-count":39,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T00:00:00Z","timestamp":1658707200000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2022,7,6]]},"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Recurrent tricuspid regurgitation (TR) is frequently observed after cardiac surgery; however, the correct approach remains controversial. We developed an algorithm for action on the tricuspid valve (TV) and conducted a 1-year follow-up study. The aim was to assess the efficacy of the algorithm to minimise residual TR after TV surgery. The hypothesis was that the TR rate at 1\u2009year would be reduced by selecting the surgical approach in accordance with a set of preoperative clinical and echocardiographic variables.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A prospective, observational, single-centre study was performed in 76 consecutive patients with TV involvement. A protocol was designed for their inclusion, and data on their clinical and echocardiographic characteristics were gathered at 3\u2009months and 1-year postsurgery. The treatment of patients depended on the degree of TR. Surgery was performed in all patients with severe or moderate-to-severe TR and in those with mild or moderate TR alongside the presence of certain clinical or echocardiographic factors. They underwent annuloplasty or extended valve repair when the TV was distorted. If repair techniques were not feasible, a prosthesis was implanted. Residual TR rates were compared with published reports, and predictors of early\/late mortality and residual TR were evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>TR was functional in 69.9% of patients. Rigid ring annuloplasty was performed in 35.7% of patients, De Vega annuloplasty in 27.1%, extended repair in 11.4% and prosthetic replacement in 25.7%. TR was moderate or worse in 8.19% of patients (severe in 3.27%) at 1\u2009year postintervention. No clinical, surgical or epidemiological variables were significantly associated with residual TR persistence, although annulus diameter showed a close-to-significant association. Total mortality was 12.85% for all causes and 10% for cardiovascular causes. In multivariate analysis, left ventricular ejection fraction was related to both early and late mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Severe residual TR was significantly less frequent than reported in other series, being observed in less than 4% of patients at 1-year postsurgery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2022-002011","type":"journal-article","created":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T11:45:14Z","timestamp":1658749514000},"page":"e002011","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Surgical management of tricuspid regurgitation: a new algorithm to minimise recurrent tricuspid regurgitation"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5678-6810","authenticated-orcid":false,"given":"Diego","family":"Rodriguez Torres","sequence":"first","affiliation":[{"name":"Universidad de Granada, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"Torres Quintero","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Segura Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Universitario San Cecilio, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Manuel","family":"Garrido Jimenez","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Esteban Molina","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Gomera Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Moreno Escobar","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Universitario San Cecilio, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocio","family":"Garcia Orta","sequence":"additional","affiliation":[{"name":"Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,7,25]]},"reference":[{"key":"2025081710155936000_9.2.e002011.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2004.06.057"},{"key":"2025081710155936000_9.2.e002011.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.09.048"},{"key":"2025081710155936000_9.2.e002011.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(98)01064-9"},{"key":"2025081710155936000_9.2.e002011.4","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.amjcard.2018.09.016","article-title":"Prevalence and outcomes of isolated tricuspid valve surgery among Medicare beneficiaries","volume":"123","author":"Kundi","year":"2019","journal-title":"Am J Cardiol"},{"key":"2025081710155936000_9.2.e002011.5","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.athoracsur.2019.03.004","article-title":"Outcomes of isolated tricuspid valve surgery have improved in the modern era","volume":"108","author":"Hamandi","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"2025081710155936000_9.2.e002011.6","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(00)00598-4"},{"key":"2025081710155936000_9.2.e002011.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.039"},{"key":"2025081710155936000_9.2.e002011.8","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivs107"},{"key":"2025081710155936000_9.2.e002011.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2003.11.019"},{"key":"2025081710155936000_9.2.e002011.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.03.047"},{"key":"2025081710155936000_9.2.e002011.11","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs441"},{"key":"2025081710155936000_9.2.e002011.12","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2010.05.002"},{"key":"2025081710155936000_9.2.e002011.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2010.02.046"},{"key":"2025081710155936000_9.2.e002011.14","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2008.152793"},{"key":"2025081710155936000_9.2.e002011.15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.991018"},{"key":"2025081710155936000_9.2.e002011.16","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1016\/j.mayocp.2019.04.036","article-title":"Prognostic importance and predictors of survival in isolated tricuspid regurgitation: a growing problem","volume":"94","author":"Fender","year":"2019","journal-title":"Mayo Clin Proc"},{"key":"2025081710155936000_9.2.e002011.17","first-page":"e72","article-title":"ACC\/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American heart association joint Committee on clinical practice guidelines","volume":"2021","author":"Otto","year":"2020","journal-title":"Circulation"},{"key":"2025081710155936000_9.2.e002011.18","first-page":"727","article-title":"ESC\/EACTS guidelines for the management of valvular heart disease","volume":"2021","author":"Vahanian","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025081710155936000_9.2.e002011.19","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-315004"},{"key":"2025081710155936000_9.2.e002011.20","doi-asserted-by":"crossref","DOI":"10.1016\/j.amjcard.2018.04.003","article-title":"Timing of referral of patients with severe isolated tricuspid valve regurgitation to surgeon","volume":"122","author":"Dreyfus","year":"2018","journal-title":"Am J Cardiol"},{"key":"2025081710155936000_9.2.e002011.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2010.05.050"},{"key":"2025081710155936000_9.2.e002011.22","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/j.athoracsur.2016.06.004","article-title":"Performing concomitant tricuspid valve repair at the time of mitral valve operations is not associated with increased operative mortality","volume":"103","author":"Badhwar","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"2025081710155936000_9.2.e002011.23","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1016\/j.athoracsur.2019.07.035","article-title":"Outcomes of guideline-directed concomitant annuloplasty for functional tricuspid regurgitation","volume":"109","author":"Brescia","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2025081710155936000_9.2.e002011.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.04.028"},{"key":"2025081710155936000_9.2.e002011.25","first-page":"10","article-title":"Outcomes after surgery for functional tricuspid regurgitation: a systematic review and meta-analysis","volume":"6","author":"Veen","year":"2020","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2025081710155936000_9.2.e002011.26","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(03)00028-6"},{"key":"2025081710155936000_9.2.e002011.27","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-007-3721-3"},{"key":"2025081710155936000_9.2.e002011.28","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.amjcard.2019.05.066","article-title":"Predictors and outcomes of persistent tricuspid regurgitation after transcatheter aortic valve implantation","volume":"124","author":"Yoshida","year":"2019","journal-title":"Am J Cardiol"},{"key":"2025081710155936000_9.2.e002011.29","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1093\/ehjci\/jex031","article-title":"Pre- and postoperative tricuspid regurgitation in patients with severe symptomatic aortic stenosis: importance of pre-operative tricuspid annulus diameter","volume":"19","author":"Dumont","year":"2018","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025081710155936000_9.2.e002011.30","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2009.217570"},{"key":"2025081710155936000_9.2.e002011.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2010.11.014"},{"key":"2025081710155936000_9.2.e002011.32","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1159\/000367589","article-title":"Preoperative risk factors for residual tricuspid regurgitation after isolated left-sided valve surgery: a systematic review and meta-analysis","volume":"129","author":"Zhu","year":"2014","journal-title":"Cardiology"},{"key":"2025081710155936000_9.2.e002011.33","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-11-0718"},{"key":"2025081710155936000_9.2.e002011.34","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.553289"},{"key":"2025081710155936000_9.2.e002011.35","doi-asserted-by":"crossref","first-page":"I14","DOI":"10.1161\/CIRCULATIONAHA.104.524496","article-title":"Impact of the maze operation combined with left-sided valve surgery on the change in tricuspid regurgitation over time","volume":"112","author":"Kim","year":"2005","journal-title":"Circulation"},{"key":"2025081710155936000_9.2.e002011.36","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000156449.49998.51"},{"key":"2025081710155936000_9.2.e002011.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2008.01.011"},{"key":"2025081710155936000_9.2.e002011.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2010.10.042"},{"key":"2025081710155936000_9.2.e002011.39","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.jacc.2020.11.066","article-title":"Progression of tricuspid regurgitation after surgery for ischemic mitral regurgitation","volume":"77","author":"Bertrand","year":"2021","journal-title":"J Am Coll Cardiol"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2022-002011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:16:08Z","timestamp":1755450968000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2022-002011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":39,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,7,25]]},"published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1136\/openhrt-2022-002011"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2022-002011","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7]]}}}