title: Prophylactic Tricuspid Annuloplasty in Patients Undergoing Double Valve Revlacement.
abstract: OBJECTIVE
  The study aim was to evaluate the effect of prophylactic tricuspid annuloplasty (TAP) on late tricuspid regurgitation (TR) after double valve (aortic and mitral) replacement (DVR).
  
  
  METHODS
  Among 239 patients undergoing DVR at the authors' institution between 1994 and 2009, a total of 93 patients who had a less than moderate degree of preoperative TR was analyzed. Concomitant TAP was performed in 55 patients (TAP group). The mean follow up duration was 7.3 +/- 4.1 years (maximum 15.9 years). Serial echocardiographic data at one, three, five and more than seven years were analyzed.
  
  
  RESULTS
  There was no early mortality, but eight late cardiac-related mortalities occurred (8.6%). In the aortic position, the transprosthetic mean pressure gradient (TMPG) was increased during follow up (13.5 +/- 5.3 mmHg versus 16.4 +/- 10.2 mmHg, p = 0.006). However, the mitral TMPG did not change significantly (3.7 +/- 1.4 mmHg versus 3.8 +/- 1.6 mmHg, p = 0.677). Freedom from valve-related events at 10 years was higher in the TAP group than in the non-TAP group (85.2 +/- 5.9% versus 63.3 +/- 0.9%; p = 0.05). Freedom from more than moderate TR at 10 years was also higher in the TAP group (93.6 +/- 4.7% versus 66.3 +/- 10.3%; p = 0.03). The transmitral pressure gradient was associated with valve-related events (p = 0.025; HR, 1.367). An absence of TAP was predictive of late TR (p = 0.020; HR, 4.4).
  
  
  CONCLUSIONS
  The study results suggested that TAP can be considered in patients who require DVR, even if the TR grade is less than moderate, in order to prevent the late occurrence of TR.
authors.forename: Dong Seop
authors.initials: DS
authors.lastname: Jeong
authors.forename: Man-shik
authors.initials: MS
authors.lastname: Shim
authors.forename: Kiick
authors.initials: K
authors.lastname: Sung
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Kim
authors.forename: Young Tak
authors.initials: YT
authors.lastname: Lee
authors.forename: Pyo Won
authors.initials: PW
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014463:Ultrasonography