Evolution of tricuspid regurgitation after mitral valve repair for functional mitral regurgitation in dilated cardiomyopathy

Objective: To assess the evolution of tricuspid regurgitation (TR) in dilated cardiomyopathy (DCM) patients submitted to mitral repair for functional mitral regurgitation (MR). Methods: Ninety-one DCM patients (mean age 61 +/- 11.3) submitted to MV repair (+/- tricuspid repair) for functional MR were included. Preoperative EF was 30.9 +/- 6.5%, left ventricular (W) end-diastolic volume 113 +/- 31.5 ml/m(2), LV end-systolic volume 81.8 +/- 26.7 ml/m(2), functional MR >= 3+/4+. TR was classified as <= 1 +/4+ in 57 patients (62.6%), 2+/4+ in 21 (23%) and >= 3+/4+ in 13 (14.2%). Most of the patients were in NYHA class III or IV. A tricuspid annuiopiasty was associated to mitral repair whenever preoperative TR was >= 3+. Therefore 13 patients (14.2%) underwent concomitant tricuspid annuloplasty whereas the remaining 78 (with preoperative TR <= 2+) did not. Results: At follow-up (mean 1.8 +/- 1.2 years), 12% of the patients (11/91) had stilt 3-4+ TR due to failure of the tricuspid repair or progression of untreated <= 2+ TR. Freedom from TR >= 3+ was 78 +/- 8.8% at 3.5 years. Among the 78 patients not submitted to tricuspid repair, 14 (18%) showed a progression of TR severity equal or greater than two grades. The multivariate analysis identified grade of TR at discharge (OR 5.4, p = 0.01) and preoperative RV dysfunction (OR 19.6, p, = 0.02) as the only independent predictors of TR >= 3+/4+ at follow-up. Conclusions: A significant number of patients submitted to mitrat repair for functional MR present >= 3+ TR at follow-up as consequence of progression of untreated TR or failure of tricuspid repair. A more aggressive and effective treatment of functional TR in this setting should be pursued. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.