Late tricuspid regurgitation following mitral valve surgery: prevalence and possible risk factors

ABSTRACT

Tricuspid regurgitation [TR] may progress or newly develop late after mitral valve surgery without significant mitral stenosis, regurgitation or other causes of left heart failure. The aim of this work was to study the prevalence and the possible risk factors for significant TR late after mitral valve replacement, as assessed both clinically and echocardiographically. A total of 145 patients [87 women, 58 men; mean age 27.9 +/- 8.53 years] who underwent mitral valve replacement were studied. Analysis was based on preoperative and last postoperative Doppler echocardiographic evaluation. Significant TR was defined echocardiographically by grade 3+ or 4+ TR, Preoperative and intraoperative variables were used to evaluate predictors of TR development by multivariate logistic regression model. Echocardiography revealed significant late TR [3 +/- or more] in 19 patients [13.1%] during the follow-up period. In univariate analysis, female gender, atrial fibrillation, huge left atrium, preoperative severe pulmonary hypertension and preoperative 2+ TR were significant risk factors for TR development multivariate logistic regression model identified female gender, atrial fibrillation, preoperative severe pulmonary hypertension and, preoperative 2+ TR as statistically significant predictors for late TR after mitral valve surgery. Significant TR late after mitral valve surgery occurs in 13.1% of patients Therefore, a lower threshold for tricuspid valve repair should be considered at the time of initial surgery particularly in female patients with severe pulmonary hypertension or atrial fibrillation, evently preoperative TR is 2+. Echo Doppler study can be considered the elective approach for preoperative evaluation of tricuspid involvement in patients with mitral valve disease