Development of tricuspid regurgitation late after left-sided valve surgery: A single-center experience with long-term echocardiographic examinations

Objectives This study sought to investigate the incidence and identify the predictors of significant tricuspid regurgitation (TR) development long after left-sided valve surgery. Methods Of 615 patients who underwent surgery for left-sided valve disease between 1992 and 1995, 335 patients without significant TR who completed at least 5 years of clinical and echocardiographic follow-up were enrolled. Late significant TR development was assessed by echocardiography with a mean follow-up duration of 11.6 +/- 2.1 years. Results Significant late TR was found in 90 patients (26.9%). Patients with late TR showed an advanced age (47.6 +/- 13.4 vs 44.3 +/- 13.2 years, P =.04), a higher prevalence of preoperative atrial fibrillation (83.3 vs 46.5%, P <.001), a greater left atria] dimension (56.9 +/- 13.2 vs 52.4 +/- 11.5mm, P =.006), and a higher prevalence of prior valve surgery (40.0 vs 25.3%, P =.01). In addition, late TR occurred more frequently in patients who had undergone mitral valve surgery than in those who did not (93.3 vs 72.2%, P <.001). However, multivariate analysis showed that the presence of preoperative atrial fibrillation (odds ratio 5.37; 95% CI 2.71-10.65; P <.001) was the only independent factor of late TR development. Patients who developed late TR had a lower event-free survival rate than those who did not (P =.03). Conclusions The development of significant TR long after left-sided valve surgery is not uncommon with an estimated incidence of 27% and is closely associated with a poor prognosis. The presence of preoperative atria[ fibrillation was identified as the only independent predictor of the development of late TR.