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Factors Associated with Development of Late Significant Tricuspid Regurgitation After Successful Left-sided Valve Surgery
  1. Hyun Song
  1. Asan Medical Center, Korea, Republic of
    1. Mi-Jeong Kim
    1. Asan Medical Center, Korea, Republic of
      1. Cheol Hyun Chung
      1. Asan Medical Center, Korea, Republic of
        1. Suk Jung Choo
        1. Asan Medical Center, Korea, Republic of
          1. Meong Gun Song
          1. Asan Medical Center, Korea, Republic of
            1. Jong-Min Song
            1. Asan Medical Center, Korea, Republic of
              1. Duk-Hyun Kang
              1. Asan Medical Center, Korea, Republic of
                1. Jae Won Lee
                1. Asan Medical Center, Korea, Republic of
                  1. Jae-Kwan Song (jksong{at}amc.seoul.kr)
                  1. Asan Medical Center, Korea, Republic of

                    Abstract

                    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: We analyzed 638 patients (356 men, mean age 52 ± 14 years) who had mild (grade 2/4) TR and underwent successful surgery without any procedure for TR. Development of significant TR was defined as TR increase by more than 1 grade and final TR grade 3/4 at follow-up echocardiography. Clinical events were defined as cardiovascular death and repeated open heart surgery. The overall incidence of late significant TR was 7.7% (49/638). Age (hazard ratio [HR], 1.0, 95% confidence interval [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 etiology (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 101꼉24 months, patients who developed late significant TR showed significantly lower 8-year clinical event-free survival rate (76 ± 6 versus 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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