title: Tricuspid regurgitation is uncommon after mitral valve repair for degenerative diseases.
abstract: To determine the incidence and effects of tricuspid regurgitation (TR) after surgery for mitral valve (MV) repair for mitral regurgitation (MR) due to degenerative disease.
  
  
  
  We examined 1171 patients who had MV repair and were followed prospectively with periodical clinical and echocardiographic assessments during a mean of 9.1 ± 5.3 years. Patients' mean age was 58.2 ± 12.7 years, and 70.5% were men. Preoperatively, 44.6% were in functional classes III and IV, 20.1% had atrial fibrillation, and 34.2% had ejection fraction <60%. In addition to MV repair, 13.8% had coronary artery bypass, 11.4% had the maze procedure, and 4.7% had tricuspid annuloplasty.
  
  
  
  Moderate and severe TR was present in 138 patients before surgery and associated with older age, preoperative atrial fibrillation, preoperative congestive heart failure, congenital heart septal defects, lower preoperative left ventricular ejection fraction, and female sex by multivariable analysis. TR resolved postoperatively but recurrent or new isolated TR occurred in 45 patients postoperatively (13.6% at 15 years in all patients). Factors associated with isolated postoperative TR by multivariable analysis included older age at operation, unrepaired preoperative moderate/severe TR, and the development of postoperative MR. Patients with preoperative TR had reduced long-term survival and tricuspid annuloplasty did not restore lifespan.
  
  
  
  Preoperative TR in patients with MR due to degenerative diseases was associated with longstanding MV disease and adversely affected long-term survival after MV repair. New postoperative TR was uncommon. The findings of this study are compelling reasons to repair the MV before the development of TR.
authors.affiliation: Division of Cardiovascular Surgery of Peter Munk Cardiac Centre at Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. Electronic address: tirone.david@uhn.ca.
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
authors.affiliation: Division of Cardiovascular Surgery of Peter Munk Cardiac Centre at Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: David
authors.affiliation: Division of Cardiovascular Surgery of Peter Munk Cardiac Centre at Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Chun-Po S
authors.initials: CS
authors.lastname: Fan
authors.affiliation: Division of Cardiovascular Surgery of Peter Munk Cardiac Centre at Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology
keywords: mitral insufficiency; mitral valve repair; tricuspid insufficiency; tricuspid valve