title: Clinical and hemodynamic influences of prophylactic tricuspid annuloplasty in mechanical mitral valve replacement.
abstract: OBJECTIVE
  The aim of this study was to evaluate the long-term clinical and hemodynamic influences of prophylactic tricuspid annuloplasty (TAP) in patients with less-than-moderate tricuspid regurgitation (TR) who underwent mitral valve replacement (MVR).
  
  
  METHODS
  Between November 1994 and December 2010, 293 patients with less-than-moderate TR who underwent primary mechanical MVR were categorized into 2 groups: TAP (n = 151) or no TAP (n = 142). The median age was 51 years (quartile (Q)1-Q3, 43-59 years). The cause of valve pathology was rheumatic in 92.5% of patients (n = 271). The prevalence of preoperative atrial fibrillation was in 73.0%. Using propensity score matching based on demographic information, 91 TAP patients could be matched to 91 no TAP patients. Median follow-up duration was 107 months (Q1-Q3, 76-162 months).
  
  
  RESULTS
  There was no early mortality in either group. Early morbidities, including heart block were not different between groups. Although overall survival and freedom from cardiac-related mortality did not differ between groups (P = .519 and P = .115, respectively), freedom from recurrence of moderate or higher TR grade were significantly higher in the TAP group (P = .043). In subgroup analyses, these group differences of TAP were especially prominent in patients with sinus rhythm compared with patients with atrial fibrillation at discharge (P = .047 vs P = .460).
  
  
  CONCLUSIONS
  Prophylactic TAP for patients with less-than-moderate TR grade who underwent mechanical MVR can prevent late TR progression without increasing early surgical risks. Longer-term follow-up is required to determine the clinical beneficial effect of prophylactic TAP.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Heemoon
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kiick
authors.initials: K
authors.lastname: Sung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Young Tak
authors.initials: YT
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sung-Ji
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada; Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Keumhee Chough
authors.initials: KC
authors.lastname: Carriere
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: pwpark@skku.edu.
authors.forename: Pyo Won
authors.initials: PW
authors.lastname: Park
mesh_terms: D000328:Adult; D058385:Cardiac Valve Annuloplasty; D016009:Chi-Square Distribution; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006327:Heart Block / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*
keywords: mitral valve; tricuspid regurgitation; valvular annuloplasty