Predictors of functional tricuspid regurgitation after successful left-sided valve surgery

Abstract

Tricuspid regurgitation (TR) is probably the most common and anticipated complication of left-sided heart valve pathology, especially MV disease. Whether preoperative functional TR will regress or progress after successful left-sided valve surgery is unknown. The aim of this study was to identify the predictors of significant TR after successful left-sided valve surgery. A retrospective analysis was performed on a total of 56 patients who underwent left-sided valve surgery (mitral or mitro-aortic-valve surgery). We have excluded patients who had organic TR. All patients had complete clinical examination and echocardiographic studies preoperatively and clinical and echocardiographic follow-up postoperatively. Mean operative age of patients was 49.3 ± 13.7 years with a sex-ratio of 0,8. Tricuspid annuloplasty was associated to left-sided valve surgery in 18 (32%) patients. Postoperatively, significant TR was found in 13 patients (23%) with a mean follow-up of 20.5 ± 33 months. Patients with significant postoperative TR were more often female (83% vs. 48%, P = 0.03), had more often a previous mitral commissurotomy (58% vs. 23%, P = 0.02) and showed a higher prevalence of significant preoperative TR (69% vs. 42%, P = 0.04). Postoperatively, residual pulmonary hypertension ( P = 0.04), dilatation of left atrium ( P = 0.02) and dilatation of right cardiac cavities ( P = 0.01) were significant risk factors for development or progression of TR after surgery. Late onset or progression of functional TR after successful left-sided valve surgery is a significant clinical entity as it displays a great impact on patient prognosis. So, the identification of clinical and echocardiographic predictors of late TR allows an adequate screening of patients that will require tricuspid valve repair at the time of initial left-sided valve surgery.