title: Tricuspid Annuloplasty for Tricuspid Regurgitation Secondary to Left-Sided Heart Valve Disease: Immediate Outcomes and Risk Factors for Late Failure.
abstract: Tricuspid valve annuloplasty is the treatment of choice for tricuspid regurgitation (TR) secondary to left-sided heart valve disease (functional TR).
  
  
  
  Between 1999 and 2014, 527 consecutive patients (mean age, 69.6 ± 9.5 years) with grade ≥ 1+ functional TR (graded from 0-3+) underwent tricuspid annuloplasty in addition to left-sided heart valve operations at the authors' institution. The operative risk (by the European System for Cardiac Operative Risk Evaluation II [EuroSCORE II]) was 10.4% ± 12.2%. Clinical data and echocardiographic studies were reviewed retrospectively during a mean follow-up of 5.2 ± 3.5 years. Risk factors for late repair failure were identified by multivariable analysis.
  
  
  
  Either suture (De Vega) or device annuloplasty was used in 14.8% and 85.2% of patients, respectively. Concomitant mitral or aortic valve surgery was performed in 92.6% and 35.9% of cases, respectively. There were 48 (9.1%) hospital deaths. The 10-year nonparametric estimates of freedom from all-cause death, cardiac and cerebrovascular deaths, and grade ≥ 2+ TR were 51.2% (95% confidence interval [CI], 47.8%-54.6%) 69.9% (95% CI, 67%-72.8%), and 77.8% (95% CI, 74.2%-81.4%), respectively. A left ventricular ejection fraction < 50% (P = 0.027), tricuspid annular diameter > 40 mm (P = 0.001), and use of De Vega annuloplasty (P = 0.019) were predictors of grade ≥ 2+ TR during the follow-up period. There was a strong link between grade ≥ 2+ TR and new left-sided valvular lesions (odds ratio, 5.3; P < 0.0001), primarily mitral regurgitation.
  
  
  
  After device annuloplasty and in the absence of preoperative left ventricular dysfunction and severe tricuspid annular dilatation, functional TR is generally controlled within grade 1+ during the follow-up period. Recurrent TR is associated with new left-sided valvular lesions.
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy. Electronic address: gius.gatti@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Dell'Angela
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Morosin
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Maschietto
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Forti
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Benussi
authors.affiliation: Department of Cardiology, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Nicolosi
authors.affiliation: Division of Cardiology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Aniello
authors.initials: A
authors.lastname: Pappalardo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D058385:Cardiac Valve Annuloplasty / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*