title: Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement.
abstract: BACKGROUND
  The development of late tricuspid regurgitation (TR) following left cardiac valve replacement is an important complication, as it is associated with a severe impairment of exercise capacity and a poor symptomatic outcome. The pathogenesis of this condition remains poorly defined. It is still a challenge in terms of its prevention, treatment and indications for surgical correction.
  
  
  OBJECTIVE
  To investigate the possible pathogenesis and report the surgical results of the late TR after left cardiac valve replacement.
  
  
  METHODS
  There were 56 patients with moderate to severe TR after left cardiac valve replacement, divided into normal prosthesis group (10 patients with normal prosthetic valve function) and dysfunctional prosthesis group (46 patients with prosthetic valve dysfunction). In the normal prosthesis group, 4 patients underwent mitral valve replacement (MVR) and 6 patients underwent combined mitral and aortic valve replacement (DVR). Patients in the dysfunctional prosthesis group included MVR in 36, aortic valve replacement (AVR) in 4 and DVR in 6, with bioprosthetic valve dysfunction occurring in 18, mechanical prosthetic valve obstruction in 22 and periprosthetic valve leakage in 6 patients. At the initial operation, 10 patients underwent DeVega's tricuspid annuloplasty and 46 patients' tricuspid valves were normal. At the second operation, the surgical treatment of TR included tricuspid valve replacement (TVR) in 9 and tricuspid annuloplasty in 47.
  
  
  RESULTS
  Two patients died postoperatively giving a 3.6% hospital mortality. The 54 survivors were followed up for 6-132 months (mean of 79.4 months). Heart function improved significantly in 8 with TVR and in 40 with tricuspid annuloplasty. Echocardiography showed moderate TR in 5 and severe TR in 1 patient with tricuspid annuloplasty who need a further surgical treatment.
  
  
  CONCLUSIONS
  Pulmonary hypertension, myocardial dysfunction, and atrial fibrillation might be responsible for the development of late TR after left cardiac valve replacement. Tricuspid annuloplasty, as the surgical method of first choice, resulted in improvement in 87% of patients with late TR after left cardiac valve replacement. TVR can also be safely applied to repair organic disease and the extremely dilated tricuspid valve annulus. If the TR area is more than 25cm(2), the TVR is recommended.
authors.affiliation: Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou 510100, PR China. xiaoxuejun@163.net
authors.forename: Xue-jun
authors.initials: XJ
authors.lastname: Xiao
authors.forename: Huan-lei
authors.initials: HL
authors.lastname: Huang
authors.forename: Jing-fang
authors.initials: JF
authors.lastname: Zhang
authors.forename: Ruo-bin
authors.initials: RB
authors.lastname: Wu
authors.forename: Jing-gong
authors.initials: JG
authors.lastname: He
authors.forename: Cong
authors.initials: C
authors.lastname: Lu
authors.forename: Zhong-min
authors.initials: ZM
authors.lastname: Li