title: Moderate tricuspid regurgitation with left-sided degenerative heart valve disease: to repair or not to repair?
abstract: BACKGROUND
  Uncertainty about long-term effects of surgically unaddressed moderate (2+) secondary tricuspid valve (TV) regurgitation (TR) accompanying left-sided degenerative heart valve disease led us to identify reasons for and factors associated with TV repair, compare safety and clinical effectiveness of relieving TR, and identify factors associated with severe (3/4+) postoperative TR.
  
  
  METHODS
  From 1997 to 2008, 1,724 patients with 2+ TR underwent 830 mitral, 703 aortic, and 191 double-valve procedures; 91 (5%) had concomitant TV repair. Logistic regression analysis was used to identify factors associated with TV repair and for propensity-matched comparison of safety (in-hospital morbidity, mortality) and effectiveness of TV repair (longitudinal echocardiographic assessment of postoperative TR and New York Heart Association class, TV intervention, survival).
  
  
  RESULTS
  Factors associated with TV repair of 2+ TR included larger right ventricles and left ventricles (p<0.001), greater TV tethering height (p=0.0002), and prior concurrent mitral valve procedures (p≤0.004). In-hospital complications, subsequent TV interventions, and intermediate-term survival were similar for matched patients. The TV repair patients had less 3/4+ TR at discharge (7% versus 15%), sustained out to 3 years. No TV repair (p=0.05), female sex (p<0.0001), and mitral valve replacement (p=0.008) were associated with 3/4+ TR.
  
  
  CONCLUSIONS
  A TV repair for moderate TR concomitant with surgery for degenerative left-sided heart valve disease is reasonable to provide an opportunity to prevent its progression and development of right ventricle dysfunction, particularly for patients with important right ventricle remodeling and evidence of right ventricular failure, and for patients with advanced left-sided disease requiring mitral valve replacement.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. naviaj@ccf.org
authors.forename: Jose L
authors.initials: JL
authors.lastname: Navia
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Brozzi
authors.forename: Allan L
authors.initials: AL
authors.lastname: Klein
authors.forename: Lee Fong
authors.initials: LF
authors.lastname: Ling
authors.forename: Chanapong
authors.initials: C
authors.lastname: Kittayarak
authors.forename: Edward R
authors.initials: ER
authors.lastname: Nowicki
authors.forename: Lillian H
authors.initials: LH
authors.lastname: Batizy
authors.forename: Jiansheng
authors.initials: J
authors.lastname: Zhong
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D000368:Aged; D003657:Decision Making; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D016277:Ventricular Function, Left