title: Evolution of repaired and non-repaired tricuspid regurgitation in rheumatic mitral valve surgery without severe pulmonary hypertension.
abstract: The aim of this study was to evaluate the usefulness of repairing significant tricuspid regurgitation (> or = grade 2) without severe pulmonary hypertension (< or = 50 mm Hg). Between 1993 and June 2001, 88 consecutive patients were operated on for rheumatic mitral valve disease associated with significant tricuspid regurgitation and without severe pulmonary hypertension. The severity of the tricuspid valve disease was assessed by echocardiography. Sixty-three patients had severe (> or = grade 3) tricuspid regurgitation (Group I), and 25 patients had moderate (grade 2) tricuspid regurgitation (Group II). There was no hospital mortality. six patients died during follow-up. The overall actuarial survival rate for 8 years was 92.1% +/- 3.1%. Cox proportional hazard regression analysis showed that age ( p = 0.006) and pulmonary complication ( p = 0.01) were associated with increased late mortality. Freedom from death was similar in both groups at 8 years (93.1% +/- 3.3% versus 88% +/- 8%, p = 0.7). Severe postoperative tricuspid regurgitation (> or = grade 3), caused by the failure of tricuspid repair or leaving the valve untouched, impaired long-term survival after surgery, and actuarial survival was 96.1% +/- 2.7% and 83% +/- 7.8% at 7 years ( p = 0.048), respectively. Severe tricuspid regurgitation, functional or organic, should be corrected at the time of mitral valve surgery, whereas untouched functional moderate tricuspid regurgitation improves after mitral valve surgery.
authors.affiliation: Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey. imkkirali@yahoo.com
authors.forename: Kaan
authors.initials: K
authors.lastname: Kirali
authors.forename: Suat Nail
authors.initials: SN
authors.lastname: Omeroğlu
authors.forename: Kemal
authors.initials: K
authors.lastname: Uzun
authors.forename: Vedat
authors.initials: V
authors.lastname: Erentuğ
authors.forename: Nilgün
authors.initials: N
authors.lastname: Bozbuğa
authors.forename: Ercan
authors.initials: E
authors.lastname: Eren
authors.forename: Mehmet
authors.initials: M
authors.lastname: Balkanay
authors.forename: Mete
authors.initials: M
authors.lastname: Alp
authors.forename: Cevat
authors.initials: C
authors.lastname: Yakut
mesh_terms: D000328:Adult; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D012216:Rheumatic Diseases / Q000150:complications*; D016019:Survival Analysis; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000209:etiology* / Q000401:mortality / Q000601:surgery