title: Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations.
abstract: 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.
authors: Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
authors: Jae-Jin
authors: JJ
authors: Kwak
authors: Yong-Jin
authors: YJ
authors: Kim
authors: Min-Kyung
authors: MK
authors: Kim
authors: Hyung-Kwan
authors: HK
authors: Kim
authors: Jin-Shik
authors: JS
authors: Park
authors: Kyung-Hwan
authors: KH
authors: Kim
authors: Ki-Bong
authors: KB
authors: Kim
authors: Hyuk
authors: H
authors: Ahn
authors: Dae-Won
authors: DW
authors: Sohn
authors: Byung-Hee
authors: BH
authors: Oh
authors: Young-Bae
authors: YB
authors: Park
mesh_terms: 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*