title: Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy.
abstract: OBJECTIVE
  To assess the evolution of tricuspid regurgitation (TR) in dilated cardiomyopathy (DCM) patients submitted to mitral repair for functional mitral regurgitation (MR).
  
  
  METHODS
  Ninety-one DCM patients (mean age 61+/-11.3) submitted to MV repair (+/-tricuspid repair) for functional MR were included. Preoperative EF was 30.9+/-6.5%, left ventricular (LV) end-diastolic volume 113+/-31.5 ml/m(2), LV end-systolic volume 81.8+/-26.7 ml/m(2), functional MR > or =3+/4+. TR was classified as < or =1+/4+ in 57 patients (62.6%), 2+/4+ in 21 (23%) and > or =3+/4+ in 13 (14.2%). Most of the patients were in NYHA class III or IV. A tricuspid annuloplasty was associated to mitral repair whenever preoperative TR was > or =3+. Therefore 13 patients (14.2%) underwent concomitant tricuspid annuloplasty whereas the remaining 78 (with preoperative TR < or =2+) did not.
  
  
  RESULTS
  At follow-up (mean 1.8+/-1.2 years), 12% of the patients (11/91) had still 3-4+ TR due to failure of the tricuspid repair or progression of untreated < or =2+ TR. Freedom from TR > or =3+ was 78+/-8.8% at 3.5 years. Among the 78 patients not submitted to tricuspid repair, 14 (18%) showed a progression of TR severity equal or greater than two grades. The multivariate analysis identified grade of TR at discharge (OR 5.4, p=0.01) and preoperative RV dysfunction (OR 19.6, p=0.02) as the only independent predictors of TR > or =3+/4+ at follow-up.
  
  
  CONCLUSIONS
  A significant number of patients submitted to mitral repair for functional MR present > or =3+ TR at follow-up as consequence of progression of untreated TR or failure of tricuspid repair. A more aggressive and effective treatment of functional TR in this setting should be pursued.
authors.affiliation: Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. michele.debonis@hsr.it
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lapenna
authors.forename: Flavia
authors.initials: F
authors.lastname: Sorrentino
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.forename: Antonio
authors.initials: A
authors.lastname: Grimaldi
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000503:physiopathology; D002315:Cardiopulmonary Bypass / Q000379:methods; D018450:Disease Progression; D017548:Echocardiography, Transesophageal / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology*; D020257:Ventricular Remodeling / Q000502:physiology*