title: Severe tricuspid regurgitation after mitral valve surgery: the risk factors and results of the aggressive application of prophylactic tricuspid valve repair.
abstract: OBJECTIVE
  This study aimed to examine the risk factors for severe postoperative tricuspid regurgitation (TR) in patients undergoing mitral valve surgery. We also studied the effects of prophylactic tricuspid valve repair (TVR) on severe postoperative TR.
  
  
  METHODS
  We retrospectively studied 125 patients without severe TR who underwent mitral valve surgery from 1987 to 2006. Patients did not undergo TVR before 1998 (the early period, n = 54). In 1998 (the late period, n = 71), patients with a preoperative tricuspid annular diameter of ≥35 mm underwent TVR using an annuloplasty ring (n = 52).
  
  
  RESULTS
  In the analysis of the early period, the rates of freedom from severe TR at 10 and 20 years after surgery were 76 and 59 %, respectively. A multivariate analysis identified moderate preoperative TR as a significant risk factor for severe TR. In the late period, none of the 52 patients who underwent TVR developed severe TR. However, 4/19 patients who did not undergo TVR developed severe TR, and all of these four patients had a preoperative tricuspid annular diameter of ≤35 mm.
  
  
  CONCLUSIONS
  Moderate preoperative TR is a significant risk factor for severe postoperative TR in patients undergoing mitral valve surgery. The aggressive application of TVR can prevent severe postoperative TR; however, tricuspid annular dilatation might not be a good indicator for TVR.
authors: Department of Cardiovascular Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshiku, Osaka, 558-8558, Japan. htakano@dokkyomed.ac.jp.|Department of Thoracic and Cardiovascular Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, 343-8555, Japan. htakano@dokkyomed.ac.jp.
authors: Hiroshi
authors: H
authors: Takano
authors: Department of Cardiovascular Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshiku, Osaka, 558-8558, Japan.
authors: Miyoko
authors: M
authors: Hiramatsu
authors: Department of Cardiovascular Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshiku, Osaka, 558-8558, Japan.
authors: Hirota
authors: H
authors: Kida
authors: Department of Cardiovascular Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshiku, Osaka, 558-8558, Japan.
authors: Mitsuru
authors: M
authors: Uenoyama
authors: Department of Cardiovascular Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshiku, Osaka, 558-8558, Japan.
authors: Kei
authors: K
authors: Horiguchi
authors: Department of Cardiovascular Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshiku, Osaka, 558-8558, Japan.
authors: Takashi
authors: T
authors: Yamauchi
authors: Department of Cardiovascular Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshiku, Osaka, 558-8558, Japan.
authors: Keiwa
authors: K
authors: Kin
authors: Department of Cardiovascular Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshiku, Osaka, 558-8558, Japan.
authors: Yukitoshi
authors: Y
authors: Shirakawa
authors: Department of Cardiovascular Surgery, Suita Tokushukai Hospital, 21-1 Senriokanishi, Suita, 565-0814, Japan.
authors: Mitsunori
authors: M
authors: Kaneko
authors: Department of Biostatistics, Hyogo College of Medicine, 1-1 Mukugawacho, Nishinomiya, 663-8501, Japan.
authors: Takashi
authors: T
authors: Daimon
mesh_terms: D000328:Adult; D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014261:Tricuspid Valve / Q000473:pathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000517:prevention & control*
keywords: Mitral valve; Surgery; Tricuspid annular dilatation; Tricuspid regurgitation; Tricuspid valve repair