Development of tricuspid regurgitation late after left-sided valve surgery: A single-center experience with long-term echocardiographic examinations

• Published in: The American heart journal Vol. 155; no. 4; pp. 732 - 737
• Main Authors: Kwak, Jae-Jin, MD, Kim, Yong-Jin, MD, Kim, Min-Kyung, MD, Kim, Hyung-Kwan, MD, Park, Jin-Shik, MD, Kim, Kyung-Hwan, MD, Kim, Ki-Bong, MD, Ahn, Hyuk, MD, Sohn, Dae-Won, MD, FACC, Oh, Byung-Hee, MD, FACC, Park, Young-Bae, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2008; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aortic Valve - surgery; Atrial Fibrillation - complications; Biological and medical sciences; Body mass index; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Congenital diseases; Disease; Disease-Free Survival; Echocardiography; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart surgery; Heart Valve Diseases - surgery; Hospitals; Humans; Incidence; Intubation; Investigative techniques, diagnostic techniques (general aspects); Logistic Models; Male; Medical prognosis; Medical sciences; Middle Aged; Mitral Valve - surgery; Mortality; Multivariate Analysis; Postoperative Complications - epidemiology; Preoperative Care; Prostheses; Pulmonary arteries; Rheumatic diseases; Risk Factors; Statistical analysis; Stroke Volume; Time Factors; Tricuspid Valve Insufficiency - epidemiology; Tricuspid Valve Insufficiency - etiology; Ultrasonic investigative techniques; Veins & arteries; Sonography; Center; Late; Echocardiography; Left; Cardiovascular disease; Tricuspid regurgitation; Heart valve; Long term; Treatment; Cardiac valvular disease; Surgery; Development; Circulatory system; Cardiology; Tricuspid valve
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2007.11.010

Objectives This study sought to investigate the incidence and identify the predictors of significant tricuspid regurgitation (TR) development long after left-sided valve surgery. Methods Of 615 patients who underwent surgery for left-sided valve disease between 1992 and 1995, 335 patients without significant TR who completed at least 5 years of clinical and echocardiographic follow-up were enrolled. Late significant TR development was assessed by echocardiography with a mean follow-up duration of 11.6 ± 2.1 years. Results Significant late TR was found in 90 patients (26.9%). Patients with late TR showed an advanced age (47.6 ± 13.4 vs 44.3 ± 13.2 years, P = .04), a higher prevalence of preoperative atrial fibrillation (83.3 vs 46.5%, P < .001), a greater left atrial dimension (56.9 ± 13.2 vs 52.4 ± 11.5mm, P = .006), and a higher prevalence of prior valve surgery (40.0 vs 25.3%, P = .01). In addition, late TR occurred more frequently in patients who had undergone mitral valve surgery than in those who did not (93.3 vs 72.2%, P < .001). However, multivariate analysis showed that the presence of preoperative atrial fibrillation (odds ratio 5.37; 95% CI 2.71-10.65; P < .001) was the only independent factor of late TR development. Patients who developed late TR had a lower event-free survival rate than those who did not ( P = .03). Conclusions The development of significant TR long after left-sided valve surgery is not uncommon with an estimated incidence of 27% and is closely associated with a poor prognosis. The presence of preoperative atrial fibrillation was identified as the only independent predictor of the development of late TR.