title: Fate of functional tricuspid regurgitation after mitral valve repair for degenerative mitral regurgitation.
abstract: BACKGROUND
  The issue of whether functional tricuspid regurgitation (TR) should be repaired at the time of mitral valve surgery is controversial, and the long-term durability of tricuspid valve (TV) annuloplasty remains unknown.
  
  
  RESULTS
  We retrospectively reviewed 654 patients who underwent mitral valve repair for degenerative mitral regurgitation between 1991 and 2010. Preoperative TR was classed as mild, trivial or absent in 479 (73.2%) patients, moderate in 125 (19.1%) patients and severe in 50 (7.7%) patients. Concomitant TV annuloplasty was performed in 162 patients (24.8%). The mean follow up duration was 7.5±4.9 years. Postoperative transthoracic echocardiography was performed according to a fixed schedule. The long-term survival rate and freedom from re-admission for congestive heart failure were affected by the severity of TR. Although the durability of ring annuloplasty was excellent up to 10 years after surgery, the mean TR grade started to increase after 10 years. Sixteen out of 492 patients who did not undergo TV annuloplasty (3.2%) revealed progression to severe TR. Preoperative atrial fibrillation (odds ratio (OR), 4.85; 95% confidence interval (CI), 1.38-17.1; P=0.014) and preoperative TR grade (OR, 5.16; 95% CI, 1.78-14.9; P=0.003) were predictors for progression to severe TR.
  
  
  CONCLUSIONS
  Aggressive treatment with concomitant TV annuloplasty should be advocated in cases with atrial fibrillation and more than moderate TR.
authors.affiliation: Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murashita
authors.forename: Yukikatsu
authors.initials: Y
authors.lastname: Okada
authors.forename: Hideo
authors.initials: H
authors.lastname: Kanemitsu
authors.forename: Naoto
authors.initials: N
authors.lastname: Fukunaga
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Konishi
authors.forename: Ken
authors.initials: K
authors.lastname: Nakamura
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Sakon
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Koyama
mesh_terms: D000328:Adult; D000368:Aged; D058385:Cardiac Valve Annuloplasty; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality