Original article: cardiovascular
Predictors of residual tricuspid regurgitation after mitral valve surgery

https://doi.org/10.1016/S0003-4975(03)00028-6Get rights and content

Abstract

Background

Whether preoperative tricuspid regurgitation (TR) will regress or progress late after surgery is unknown. The aim of this study was to evaluate predictors of significant TR late after mitral valve surgery.

Methods

A retrospective analysis was performed on a total of 174 patients who underwent mitral valve surgery without tricuspid valve surgery. Preoperatively, 46 patients (26%) had 2+ TR, and 128 patients (74%) had 1+ or less TR. Postoperative 3+ TR was considered significant TR. Variables were used to evaluate predictors of TR development by univariate or multivariate analysis.

Results

The mean follow-up was 8.2 years (range 1.0 to 14.5 years) after surgery. There was progressive TR (3+ or more) in 28 patients (16%) during the follow-up period. In univariate analysis, atrial fibrillation, rheumatic etiology, huge left atrium, left ventricular dysfunction, and preoperative 2+ TR were significant risk factors for TR development. Multivariate analysis identified preoperative 2+ TR, atrial fibrillation, and huge left atrium as statistically significant predictors for late TR after surgery.

Conclusions

Aggressive repair of accompanying TR should be undertaken at the time of initial surgery in patients with huge left atrium or atrial fibrillation, even if preoperative TR is 2+.

Section snippets

Material and methods

Between March 1988 and September 2001, 274 patients had mitral valve surgery at our institution. Of these patients, 175 consecutive patients underwent mitral valve surgery without tricuspid valve surgery, and their records were retrospectively reviewed. Patients with concomitant procedures, such as coronary artery bypass grafting or aortic valve replacement, were excluded form this study. All patients had complete physical examinations preoperatively, with echocardiographic studies and cardiac

Results

There was one operative death. A total of 174 patients were included in this study. MVR was undergone in 76 patients, (44%) and mitral valve repair was 92 patients (56%). MVR was performed using a St. Jude Medical prosthesis (St. Paul, MN) in all patients. The mean follow-up was 8.2 ± 3.6 years (range 1.0 to 14.5 years) after surgery. There were 14 late deaths (8%). The cause of death was sudden death in 2 patients, cardiac failure in 1 patient, brain infarction or bleeding in 3 patients,

Comment

The surgical management of secondary TR due to left-sided heart valve lesions remains controversial. In this series, significant TR was present in 16% of patients late after MVR without tricuspid valve surgery.

Several mechanisms may be responsible for the high prevalence of late TR. First, persistent pressure overload due to pulmonary hypertension may contribute to TR progression [8]. However, a recent report demonstrated that preoperative pulmonary hypertension was not a risk factor for

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