title: Prognostic Impact and Late Evolution of Untreated Moderate (2/4+) Functional Tricuspid Regurgitation in Patients Undergoing Aortic Valve Replacement.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the prognostic impact and late evolution of associated tricuspid regurgitation (TR) 2/4+ after aortic valve replacement (AVR).
  
  
  METHODS
  We evaluated 61 patients who underwent AVR between 2003 and 2012 (35 for aortic stenosis [AS], 26 for aortic regurgitation [AR]) with associated untreated TR 2/4+. Patients with concomitant mitral disease were excluded. Median follow-up was 3.2 years. Serial echocardiographic and clinical data were collected and analyzed.
  
  
  RESULTS
  Mean age was 65 ± 13 years; 26% of the patients were in NYHA class III-IV. Left ventricular ejection fraction was 53 ± 11%. Comorbidity included: chronic obstructive pulmonary disease in 5%, chronic renal failure in 13%, coronary artery disease in 20%, history of stroke/TIA in 8%. Thirty-day mortality was 1.6%. Overall actuarial survival was 83 ± 6% at 6.5 years, with a freedom from cardiac death of 90 ± 5%. Freedom from TR ≥3+ was 86 ± 6% at 6.5 years. At last follow-up, 82% of the patients had TR 0-1/4+, 9% had TR 2/4+, 4.5% had TR 3/4+ and 4.5% had TR 4/4+. Occurrence of TR ≥ 3+ at follow-up was associated with increased cardiac mortality (HR 10.5; p = 0.009).
  
  
  CONCLUSIONS
  preoperative untreated TR 2/4+ improves or remains stable in the majority of patients. The poor outcomes associated with TR > 2+ suggest the need for better methods to identify subjects at risk for TR progression.
authors.affiliation: Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zürich, Switzerland.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Taramasso
authors.affiliation: Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zürich, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.affiliation: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.affiliation: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pozzoli
authors.affiliation: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Schiavi
authors.affiliation: Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zürich, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Benussi
authors.affiliation: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Grimaldi
authors.affiliation: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.affiliation: Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012306:Risk; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000503:physiopathology*; D016277:Ventricular Function, Left