title: Predictors of late improvement of significant remnant tricuspid regurgitation detected early after tricuspid annuloplasty.
abstract: BACKGROUND
  In some patients with severe tricuspid regurgitation (TR) who undergo tricuspid annuloplasty (TAP), significant remnant TR is detected early after TAP but diminishes after long-term follow-up. We sought to investigate the outcome of significant residual TR early after TAP and the predictors for late improvement of TR.
  
  
  METHODS
  A total of 58 consecutive patients presenting with moderate to severe TR early (5.7 ± 2.0 days) after TAP and before discharge were enrolled in this study. Echocardiography was repeated for 32.3 ± 28.6 months after TAP, and improvements in TR were defined as mild or less TR. Clinical data and echocardiographic studies were retrospectively analyzed.
  
  
  RESULTS
  Twenty-nine (50%) patients showed late improvement in TR during follow-up. Multivariate Cox regression analysis revealed that tricuspid valve (TV) tenting height measured early after TAP (P = 0.020) and execution of the Maze procedure with TAP (P = 0.049) were independent predictors for late improvement of significant early remnant TR. The rates of late TR improvement were higher in patients with an early postoperative TV tenting height ≥ 9.1 mm (P = 0.026) and in patients who underwent a Maze procedure (P = 0.033) than in other groups of patients.
  
  
  CONCLUSIONS
  Half of patients with significant remnant TR early after TAP show late improvement in TR. Evaluation of a combined Maze procedure and TV tenting height early after TAP will help identify patients for whom repeated TV surgery may be deferred.
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Chang Hee
authors.initials: CH
authors.lastname: Kwon
authors.affiliation: Division of Cardiology, Cheju Halla General Hospital, Jeju, Korea.
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Cho
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: jmsong@amc.seoul.kr.
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.affiliation: Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.affiliation: Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*