Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations.
OBJECTIVE
This study sought to investigate the incidence and identify the predictors of significant tricuspid regurgitation (TR) development long after left-sided valve surgery.


METHODS
Of 615 patients who underwent surgery for left-sided valve disease between 1992 and 1995, 335 patients without significant TR who completed at least 5 years of clinical and echocardiographic follow-up were enrolled. Late significant TR development was assessed by echocardiography with a mean follow-up duration of 11.6 +/- 2.1 years.


RESULTS
Significant late TR was found in 90 patients (26.9%). Patients with late TR showed an advanced age (47.6 +/- 13.4 vs 44.3 +/- 13.2 years, P = .04), a higher prevalence of preoperative atrial fibrillation (83.3 vs 46.5%, P < .001), a greater left atrial dimension (56.9 +/- 13.2 vs 52.4 +/- 11.5 mm, P = .006), and a higher prevalence of prior valve surgery (40.0 vs 25.3%, P = .01). In addition, late TR occurred more frequently in patients who had undergone mitral valve surgery than in those who did not (93.3 vs 72.2%, P < .001). However, multivariate analysis showed that the presence of preoperative atrial fibrillation (odds ratio 5.37; 95% CI 2.71-10.65; P < .001) was the only independent factor of late TR development. Patients who developed late TR had a lower event-free survival rate than those who did not (P = .03).


CONCLUSIONS
The development of significant TR long after left-sided valve surgery is not uncommon with an estimated incidence of 27% and is closely associated with a poor prognosis. The presence of preoperative atrial fibrillation was identified as the only independent predictor of the development of late TR.
Kwak
Jae-Jin
JJ
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Kim
Yong-Jin
YJ
Kim
Min-Kyung
MK
Kim
Hyung-Kwan
HK
Park
Jin-Shik
JS
Kim
Kyung-Hwan
KH
Kim
Ki-Bong
KB
Ahn
Hyuk
H
Sohn
Dae-Won
DW
Oh
Byung-Hee
BH
Park
Young-Bae
YB
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001281:Atrial Fibrillation / Q000150:complications; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology / Q000209:etiology*