Presence of tricuspid regurgitation after left-heart valve surgery independently predicts mortality

Abstract

Background: Significant tricuspid regurgitation (TR) occurring late after left-heart valve surgery is frequent and associated with decreased exercise tolerance and quality of life. Re-operative tricuspid valve (TV) surgery has been reported to result in early mortality rates as high as 10% to 25%. The aim of the study was to evaluate whether significant TR late after left-heart valve surgery impacts on prognosis. Methods: 602 consecutive patients after successful surgery of the aortic or/and the mitral valve (49±29 months post-surgery) were prospectively followed for 5 years. The severity of TR was assessed by echocardiography. Significant TR was defined as TR ≥ moderate. The primary endpoint was defined as cardiovascular death. Cox-Regression was used to determine the impact of TR on survival. Results: Significant TR was present in 122 (20.3%) patients, who were predominantly female (66% vs. 49%, p<0.001), had a higher EuroSCORE (9.8±2.5 vs. 8.9±2.3, p<0.001) and had more previous cardiac surgeries (1.2±0.5 vs. 1.1±0.3, p=0.010). They more often had atrial fibrillation (48% vs. 19%, p<0.001) and were more symptomatic (NYHA≥II 55% vs. 31% p<0.001). Patients with significant TR had larger right ventricles (36.9±7.9mm vs. 32.7±5.0mm, p<0.001), more dilated left and right atria (66.7±13.0mm vs. 57.9±8.3mm and 65.0±13.1mm vs. 55.3±7.5mm; both p<0.001) and presented with worse left ventricular function (LVEF<50%: 19% vs. 11%; p=0.020). In total, 132 (21.9%) patients died during follow up (36.1% with significant TR vs. 18.3% without; p<0.001). 76 (12.6%) patients died of cardiovascular causes (26.2% vs. 9.2%, p<0.001). By Kaplan-Meier analysis, overall survival was significantly worse in patients with significant TR (1-,3- and 5-year survival 91.8%, 81.2% and 63.9% vs. 96.0%, 89.0% and 81.7%; log rank p<0.001). By multivariable Cox regression analysis, age (p<0.001), left atrial enlargement (p<0.001), coronary artery disease (p=0.001) and significant TR (p=0.008) were found to independently predict cardiovascular mortality. Conclusion: Significant TR late after left-sided valve surgery is frequent and independently predicts mortality.