title: Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery.
abstract: BACKGROUND
  Persistent significant tricuspid regurgitation (TR) after successful left-sided valve surgery is frequently reported.
  
  
  OBJECTIVE
  To evaluate the incidence, risk factors and clinical impact of development of late significant TR after successful left-sided valve surgery.
  
  
  RESULTS
  638 patients (356 men, mean age 52 (SD 14) years) who had mild (<or=grade 2/4) TR and underwent successful surgery without any procedure for TR were analysed. Development of significant TR was defined as a TR increase by more than one grade and final TR grade >or=3/4 at follow-up echocardiography. Clinical events were defined as cardiovascular death, repeated open-heart surgery, and congestive heart failure requiring hospital admission. The overall incidence of late significant TR was 7.7% (49/638). Age (hazard ratio (HR), 1.0, 95% CI, 1.0 to 1.1; p = 0.005), female gender (HR, 5.0; 95% CI 2.0 to 12.7; p = 0.001), rheumatic aetiology (HR, 3.8; 95% CI 1.4 to 10.3; p = 0.011), atrial fibrillation (Af) (HR, 2.6; 95% CI 1.1 to 6.4; p = 0.035) and peak pressure gradient of TR at follow-up (HR, 1.1; 95% CI 1.0 to 1.1; p<0.001) were independent factors associated with development of late significant TR. During clinical follow-up of 101 (24) months, patients who developed late significant TR showed a significantly lower 8-year clinical event-free survival rate (76 (6) vs 91 (1)%, p<0.001).
  
  
  CONCLUSIONS
  Several clinical variables were independent risk factors for development of late significant TR. Early surgical intervention for TR in selected patients with these risk factors may be justified, even though they have only mild TR.
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: H
authors.initials: H
authors.lastname: Song
authors.forename: M-J
authors.initials: MJ
authors.lastname: Kim
authors.forename: C H
authors.initials: CH
authors.lastname: Chung
authors.forename: S J
authors.initials: SJ
authors.lastname: Choo
authors.forename: M G
authors.initials: MG
authors.lastname: Song
authors.forename: J-M
authors.initials: JM
authors.lastname: Song
authors.forename: D-H
authors.initials: DH
authors.lastname: Kang
authors.forename: J W
authors.initials: JW
authors.lastname: Lee
authors.forename: J-K
authors.initials: JK
authors.lastname: Song