title: Right ventricular dysfunction, but not tricuspid regurgitation, is associated with outcome late after left heart valve procedure.
abstract: BACKGROUND
  Significant tricuspid regurgitation (TR) late after left heart valve procedure is frequent and associated with increased morbidity. Surgical correction carries a significant mortality risk, whereas the impact of TR on survival in these patients is unclear.
  
  
  OBJECTIVE
  This study sought to assess the impact of significant TR late after left heart valve procedure.
  
  
  METHODS
  A total of 539 consecutive patients with previous left heart valve procedure (time interval from valve procedure to enrollment 50 ± 30 months) were prospectively followed for 53 ± 15 months.
  
  
  RESULTS
  Significant TR (defined as moderate or greater severity by echocardiography) was present in 91 (17%) patients (65% female). Patients with TR presented with more symptoms (New York Heart Association functional class ≥II 55% vs. 31%), lower glomerular filtration rates (61 ± 19 ml/min vs. 68 ± 18 ml/min), and a higher likelihood of atrial fibrillation (41% vs. 20%), all statistically significant. Right ventricular (RV) systolic function was worse in patients with significant TR (RV fractional area change 43 ± 11% vs. 47 ± 9%, p < 0.001). A total of 117 (22%) patients died during follow-up. By Kaplan-Meier analysis, overall survival was significantly worse in patients with significant TR (log-rank p < 0.001). However, by multivariable Cox analysis, only RV fractional area change, age, left atrial size, diabetes, and previous coronary artery bypass graft procedure were significantly associated with mortality, but not tricuspid regurgitation.
  
  
  CONCLUSIONS
  RV dysfunction, but not significant TR, is independently associated with survival late after left heart valve procedure.
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Andreas A
authors.initials: AA
authors.lastname: Kammerlander
authors.affiliation: Department of Thoracic Surgery, Otto Wagner Hospital, Vienna, Austria.
authors.forename: Beatrice A
authors.initials: BA
authors.lastname: Marzluf
authors.affiliation: Department of Medical Statistics, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Graf
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Alina
authors.initials: A
authors.lastname: Bachmann
authors.affiliation: Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Alfred
authors.initials: A
authors.lastname: Kocher
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Diana
authors.initials: D
authors.lastname: Bonderman
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. Electronic address: julia.mascherbauer@meduniwien.ac.at.
authors.forename: Julia
authors.initials: J
authors.lastname: Mascherbauer
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001317:Austria; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology
keywords: echocardiography; fractional area change; left heart disease; pulmonary hypertension