title: Impact of tricuspid regurgitation after redo valvular surgery on survival in patients with previous mitral valve replacement.
abstract: OBJECTIVE
  The impact on survival of tricuspid regurgitation (TR) after redo valvular surgery in patients with previous mitral valve replacement (MVR) is unclear.
  
  
  METHODS
  We retrospectively analyzed 118 consecutive patients undergoing redo valvular surgery after MVR over a 20-year period. We determined the impact of TR after redo valvular surgery on survival and clinical factors that were associated with TR of 2+ or higher. The mean follow-up period was 7.1±6.5 years.
  
  
  RESULTS
  Overall hospital mortality was 8.5% (10 of 118). Logistic regression analysis revealed that cardiopulmonary bypass duration (odds ratio, 1.025; P=.0270) was an independent risk factor for hospital death. There were 25 late deaths. Survival after 5, 10, and 15 years was 77.5%±4.2%, 68.5%±5.1%, and 58.8%±6.3%, respectively. Multivariate Cox regression analysis showed that TR less than 2+ at discharge was a predictor of late survival (hazard ratio, 0.043; P<.0382), whereas age, female sex, left ventricular end-diastolic dimension, and cardiopulmonary bypass duration were predictors of late death. Survival for patients with TR less than 2+ versus 2+ or higher after redo surgery were 91.4%±3.4% versus 59.5%±11.9% at 5 years and 81.1%±5.3% versus 52.1%±12.5% at 10 years, respectively (log-rank P=.0285). Logistic regression analysis indicated that preoperative TR (odds ratio, 3.718; P=.0044) and chronic obstructive pulmonary disease (odds ratio, 28.576; P=.0154) were independent risk factors for TR of 2+ or higher after redo surgery.
  
  
  CONCLUSIONS
  Survival in patients with TR of 2+ or higher after redo valvular surgery was poor. The results of this study suggest that it is important to maintain a postoperative TR less than 2+ to improve long-term survival.
authors: Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan. Electronic address: naotowakimachi@hotmail.co.jp.
authors: Naoto
authors: N
authors: Fukunaga
authors: Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan.
authors: Yukikatsu
authors: Y
authors: Okada
authors: Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan.
authors: Yasunobu
authors: Y
authors: Konishi
authors: Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan.
authors: Takashi
authors: T
authors: Murashita
authors: Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan.
authors: Hideo
authors: H
authors: Kanemitsu
authors: Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan.
authors: Tadaaki
authors: T
authors: Koyama
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left