Progression of Isolated Tricuspid Regurgitation Late After Left-Sided Valve Surgery - Clinical Features and Mechanisms -

Abstract

Background: Severe tricuspid regurgitation (TR) sometimes develops late after left-sided valve surgery without left heart failure, pulmonary hypertension or rheumatic tricuspid valve. The purpose of the present study was to investigate clinical characteristics and mechanisms of severe isolated TR late after left-sided valve surgery. Methods and Results:A total of 372 consecutive patients who underwent left-sided valve surgery between 1990 and 2003 and who were followed up with echocardiography for at least 5 years, were retrospectively investigated. The mean follow-up period was 9.4 years. Clinical background, preoperative and postoperative echocardiographic parameters were evaluated. Among the 372 patients, severe isolated TR was detected in 23 patients, which developed at a mean of 8.6 years after surgery. Twenty-two of 23 patients had undergone mitral valve surgery. Multivariate logistic regression analysis identified the presence of preoperative atrial fibrillation and preoperative ejection fraction as independent determinants for the development of severe isolated TR. In patients with severe isolated TR, the tricuspid annular diameter and the right atrial area were already enlarged early after surgery and both of these increased prior to TR progression.

Long-Term Outcomes of Tricuspid Annuloplasty for Functional Tricuspid Regurgitation Associated with Degenerative Mitral Regurgitation: Suture Annuloplasty Versus Ring Annuloplasty Using a Flexible Band

“…1,15) However, moderate to severe late functional TR has been reported after isolated MV surgery. 16,17) Because severe late TR is associated with high mortality and morbidity, concomitant TV annuloplasty is recommended for severe TR at the time of MV surgery to prevent progression to functional TR. However, the use of concomitant TV annuloplasty for mild/moderate functional TR remains a controversial subject, 7,8) because limited available data related to the long-term outcomes of concomitant TV annuloplasty exist.…”

Fate of Functional Tricuspid Regurgitation After Mitral Valve Repair for Degenerative Mitral Regurgitation

“…1, 13 However, moderate-to-severe late functional TR has been reported after isolated mitral surgery. 14, 15 Because severe late TR is associated with high mortality and morbidity, concomitant TV annuloplasty is recommended at the time of mitral surgery in these patients, to prevent progression of functional TR. However, previous studies have identified various mechanisms of MR, ranging from rheumatic to ischemic disease and other cardiomyopathic processes.…”

“…However, previous studies have identified various mechanisms of MR, ranging from rheumatic to ischemic disease and other cardiomyopathic processes. 1,13- 15 The type of MR affects the progression of TR. We therefore focused on degenerative mitral valve leaflet prolapse, which is the most frequent MR condition in the West.…”

Predictive factor of secondary tricuspid regurgitation after aortic valve replacement for aortic stenosis: the importance of myocardial hypertrophy and diastolic dysfunction

“…The development of moderate or greater than moderate STR after left-sided valve surgery worsens the long-term prognosis [2,4]. In previous studies, female [5][6][7], mitral stenosis [1], rheumatic etiology [1,6], atrial fibrillation [1,4,6,7], low left ventricular (LV) function [7], dilatation of the left atrium [1,4,5], pulmonary hypertension [5,7], dilatation of the right ventricle [8], preoperative TR severity [4], tricuspid valve (TV) annular dilatation [9], and TV tethering [10] were reported as predictors of STR; however, most of these reports were of patients with mitral valve disease. Although STR complicated with aortic stenosis (AS) is not uncommon [4], there is a lack of information on late STR that has developed after aortic valve replacement (AVR) for AS.…”