title: Determinants of recurrent tricuspid regurgitation following tricuspid valve annuloplasty during mitral valve surgery.
abstract: BACKGROUND
  The purpose of this study was to determine risk predictors for recurrent tricuspid regurgitation (TR) following tricuspid valve annuloplasty during mitral valve surgery.
  
  
  METHODS
  Ninety-eight consecutive patients underwent tricuspid valve annuloplasty concomitant with mitral valve repair (71 patients), replacement (16 patients), or other procedures over a 10-year period. Fifty-seven patients underwent surgery with a flexible band and 41 with a rigid ring.
  
  
  RESULTS
  Late TR progression (≥2/4) occurred in eight (14.0%) of flexible band patients, and in nine (22.0%) rigid ring patients. Multivariate analysis did not identify the superiority of one annuloplasty device over the other to prevent recurrent TR. Multivariate risk predictors of late TR progression were late atrial fibrillation (hazard ratio [HR]: 3.78; 95% confidence interval [CI]: 1.19-12.0), and recurrent mitral regurgitation; HR; 4.46; 95%CI; 1.52-13.1). Freedom from TR progression at 5 years was 89.2% in atrial fibrillation-free patients compared to 56.8% in those with atrial fibrillation (log-rank, P = 0.018), and 89.8% in mitral regurgitation-free patients compared to 55.3% in those with recurrent mitral regurgitation (log-rank, P = 0.003).
  
  
  CONCLUSIONS
  A durable mitral valve repair and preservation of sinus rhythm are the keys to preventing late TR progression.
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi, Japan.
authors.forename: Hisato
authors.identifier: http://orcid.org/0000-0003-3792-1615
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Mizumoto
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Sawada
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Fujinaga
authors.affiliation: Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo City, Aichi, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Tempaku
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Mie University, Tsu, Mie, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Shimpo
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D018450:Disease Progression; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D012008:Recurrence; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology* / Q000517:prevention & control