title: Residual Tricuspid Regurgitation following Tricuspid Valve Repair during Concomitant Valve Surgery Worsens Late Survival.
abstract: BACKGROUND
  Concomitant tricuspid valve repair (TVr) for functional tricuspid regurgitation (TR) at the time of left-sided valve surgery has become increasingly more common over the past decade. The impact of residual post-repair TR on late outcomes remains unclear.
  
  
  METHODS
  All patients undergoing TVr during concomitant left-sided valve surgery at our institution from 2005-2012 were retrospectively reviewed. Patients were stratified into 2 groups according to the degree of post-cardiopulmonary bypass TR observed on intraoperative transesophageal echocardiography; 0-1+ TR (No TR, n = 246) and ≥2+ TR (Residual TR, n = 26). Primary outcomes of interest were 30-day survival, 4-year survival, and follow-up TR grade. A propensity-matched subgroup analysis was performed in addition to the overall cohort analysis.
  
  
  RESULTS
  Mean age for all patients was 70.3 ± 13.0 years and 107 (39%) patients were male. There was no difference in 30-day survival between groups (92% No TR versus 96% Residual TR, P = .70). Kaplan-Meier analysis of overall 4-year survival showed a trend toward worsened survival in the Residual TR group (log rank P = .17) and propensity-matched subgroup analysis showed significantly worse 4-year survival for Residual TR (log rank P = .02). At mean echocardiographic follow up of 11.9 ± 22.5 months, TR grade was significantly worse in the Residual TR group compared to No TR (1.5 ± 0.8 Residual TR versus 0.9 ± 0.9 No TR, P = .005), although TR severity was significantly improved from immediately post-bypass.
  
  
  CONCLUSIONS
  Patients left with residual TR following TVr during concomitant left-sided valve surgery have significantly decreased late survival compared to patients left with no post-repair TR.
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sorabella
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
authors.forename: Erin
authors.initials: E
authors.lastname: Mamuyac
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
authors.forename: Halit
authors.initials: H
authors.lastname: Yerebakan
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
authors.forename: Marc
authors.initials: M
authors.lastname: Najjar
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
authors.forename: Vivian
authors.initials: V
authors.lastname: Choi
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Smith
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*