ORIGINAL ARTICLES

Valvular heart disease

Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery

H Song¹, M-J Kim², C H Chung¹, S J Choo¹, M G Song¹, J-M Song², D-H Kang², J W Lee¹, J-K Song²

¹ Cardiothoracic Surgery Division, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
² Cardiology Division, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Professor J-K Song, Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong Songpa-ku, Seoul 138-736, South Korea; jksong{at}amc.seoul.kr

Background: Persistent significant tricuspid regurgitation (TR) after successful left-sided valve surgery is frequently reported.

Objectives: To evaluate the incidence, risk factors and clinical impact of development of late significant TR after successful left-sided valve surgery.

Methods and results: 638 patients (356 men, mean age 52 (SD 14) years) who had mild (grade 2/4) TR and underwent successful surgery without any procedure for TR were analysed. Development of significant TR was defined as a TR increase by more than one grade and final TR grade 3/4 at follow-up echocardiography. Clinical events were defined as cardiovascular death, repeated open-heart surgery, and congestive heart failure requiring hospital admission. The overall incidence of late significant TR was 7.7% (49/638). Age (hazard ratio (HR), 1.0, 95% CI, 1.0 to 1.1; p = 0.005), female gender (HR, 5.0; 95% CI 2.0 to 12.7; p = 0.001), rheumatic aetiology (HR, 3.8; 95% CI 1.4 to 10.3; p = 0.011), atrial fibrillation (Af) (HR, 2.6; 95% CI 1.1 to 6.4; p = 0.035) and peak pressure gradient of TR at follow-up (HR, 1.1; 95% CI 1.0 to 1.1; p<0.001) were independent factors associated with development of late significant TR. During clinical follow-up of 101 (24) months, patients who developed late significant TR showed a significantly lower 8-year clinical event-free survival rate (76 (6) vs 91 (1)%, p<0.001).

Conclusions: Several clinical variables were independent risk factors for development of late significant TR. Early surgical intervention for TR in selected patients with these risk factors may be justified, even though they have only mild TR.

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