title: Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty.
abstract: BACKGROUND
  The durability of tricuspid valve (TV) repair by annuloplasty is limited. Identification of mechanisms of recurrent or residual tricuspid regurgitation (TR) after annuloplasty is necessary to improve results of TV repair. The purpose of this study was to investigate echocardiographic determinants of mid-term outcome after TV annuloplasty.
  
  
  RESULTS
  This study consisted of 39 patients with functional TR who had echocardiography preoperatively, early postoperatively (5+/-2 days), and >1 year (20+/-6 months) after TV annuloplasty. Detailed echocardiographic measurements were performed, including TR severity, TV annular dimension, TV leaflet displacement, left ventricular (LV) function, and right ventricular (RV) function and pressures. Preoperative leaflet tethering height and area predicted early and mid-term outcome of annuloplasty. Early postoperative LV ejection fraction and TR severity influenced degree of TR >1 year after surgery. In addition, increased RV pressure was related to worse TR during late follow-up.
  
  
  CONCLUSIONS
  Although TV tethering is an important determinant of recurrent or residual TR, LV and RV function and pressures impact repair durability. These factors identify patients at risk for repair failure; such individuals require development of additional surgical strategies to improve results of tricuspid valve repair and close surveillance after surgery.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F15, Cleveland, Ohio 44195, USA.
authors.forename: Shota
authors.initials: S
authors.lastname: Fukuda
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
authors.forename: William J
authors.initials: WJ
authors.lastname: Stewart
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Takashi
authors.initials: T
authors.lastname: Kihara
authors.forename: Masao
authors.initials: M
authors.lastname: Daimon
authors.forename: Mi-Seong
authors.initials: MS
authors.lastname: Shin
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D016208:Databases, Factual; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D009038:Motion; D015588:Observer Variation; D019736:Prostheses and Implants; D012008:Recurrence; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume; D013536:Suture Techniques; D013599:Systole; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*