Surgery in Secondary Tricuspid Regurgitation
Surgery in Secondary Tricuspid Regurgitation
Currently, in cardiology/cardiosurgery the indicators for the surgical correction of
 secondary tricuspid regurgitationare unclear. AIM: To compare right ventricle structural and
 functional changes after operation in patients with secondary tricuspid regurgitation with
 severe mitral /aortic valve pathology, requiring surgical intervention; define the factors
 influencing major adverse cardiac events depending on the operation/non-operation due to
 moderate tricuspid regurgitation. This study intends to include 200-300 people and will occur
 over 5 years with an additional 3-year follow-up.
Background It has been demonstrated in recent large patient monitoring registers that the
 presence of even mild secondary tricuspid regurgitation (TR) has a significant effect on life
 expectancy. Currently, in cardiology/cardiosurgery the indicators for the surgical correction
 of secondary TR are unclear. In this area, international guidelines lack randomized studies
 and are based on a C level of evidence. C level evidence is based solely on the opinion of
 experts, retrospective, and/or observational studies. The first indicator for tricuspid valve
 (TV) surgery is considered to be a combination of TR with severe aortic or mitral valve
 lesions that require surgical treatment. However, the level of indicators for moderate
 corrections in such situations is typically II A-B. At the C level of evidence there is no
 consensus for surgical treatment of such a defect in the international community. Severe TR
 indicators are Class I while the evidence remains C level because it is not well established
 that surgical treatment improves the prognosis of these patients. There is a lack of
 information about the structural and functional changes of the right ventricle after surgery
 depending on the degree of TR.

 Aims and objectives of studying AIM: To compare right ventricle structural and functional
 changes after operation in patients with secondary tricuspid regurgitation with severe mitral
 /aortic valve pathology, requiring surgical intervention; define the factors influencing
 major adverse cardiac events depending on the operation/non-operation due to moderate
 tricuspid regurgitation.

 OBJECTIVES:

 1. To study tricuspid regurgitation parameters affecting the long-term prognosis for the
 surgical correction of severe secondary tricuspid regurgitationof patients with severe
 aortic/mitral valve pathology requiring surgical treatment.

 2. To define hemodynamic parameters of patients with moderate tricuspid regurgitation, when
 surgical treatment of this defect gives an additional improvement in the short-term and
 long-term prognosis following surgical treatment of severe aortic/mitral valve diseases.

 3. To study changes in contractility parameters in the right ventricle and tricuspid valve
 function after reconstructive surgery over a period of 3 years.

 Methods and study plans This study intends to include 200-300 people and will occur over 5
 years with an additional 3-year follow-up.

 Inclusion criterion: 1) Signed informed consent form, 2) Previously diagnosed aortic or
 mitral heart diseases requiring surgical treatment, 3) Over 18 years of age 4) The presence
 of moderate or severe secondary tricuspid insufficiency.

 Exclusion criterion: 1) Significant oncology diseases with a known prognosis of a less than 1
 year life expectancy.

 Cardiologist examination and survey. Echocardiography All patients will undergo standard
 echocardiography, including a detailed study of the function and sizes of the right ventricle
 and right atrium, and measurement of global longitudinal left ventricular deformations using
 the Speckle Tracking method, peak systolic and diastolic blood flow velocity in TV,
 fractional changes in area, and tricuspid annulus systolic excursion. Tricuspid regurgitation
 will be measured according to the standards of EAE/ASE, and will also use the recent 3-tiered
 classification system of severe insufficiency.

 Laboratory techniques Standard for surgical treatment of aortic/mitral valve Coronary
 catheterization Standard for surgical treatment of aortic/mitral valve, Plan I. Initial visit
 - cardiologist/cardiosurgeon clinical evaluation - survey and examination II.
 Echocardiography study - screening - defining degree of tricuspid regurgitation III. Common
 tests for surgical treatment of aortic/mitral valve IV. Patient randomization with only a
 moderate degree of TR V. Surgical treatment VI. 30-40 days after surgery - cardiologist
 examination VII. 90 days after surgery ¬ - cardiologist examination + echocardiography VIII.
 1 year after surgery - cardiologist examination + echocardiography IX. 3 years after surgery
 - cardiologist examination + echocardiography Expected benefits for patients All patients
 will receive advanced tests using the latest safe ultrasound methods. Frequent
 echocardiography and patient observations can reveal possible complications after cardiac
 surgery for aortic/mitral diseases; This study will allow for the correction of drug therapy
 due to extended diagnosis.

 Severe lesions of the tricuspid valve and aortic / mitral heart defects will be corrected in
 all patients.

 New and / or untested methods of treatment will not be used in this study. All surgical
 procedures will already have undergone testing and been proven effective for the treatment of
 heart diseases.
Inclusion Criteria:

 1. Age > 18 years

 2. Indication left-side valve surgery

 Exclusion Criteria:

 1. Unwillingness to give informed consent and to enter a regular follow-up program.

 2. Prior surgical or percutaneous mitral valve intervention

 3. Contraindication to cardiopulmonary bypass (CPB)

 4. Clinical signs of cardiogenic shock at the time of randomization