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Mitral valve surgery for functional mitral regurgitation: prognostic role of tricuspid regurgitation

^a Department of Cardiac Surgery, University of Catania, Catania, Italy
^b Department of Cardiology, University of Chieti, Chieti, Italy

Received 8 August 2008; received in revised form 27 November 2008; accepted 4 December 2008.

^_* Corresponding author. Address: Division of Cardiac Surgery, University of Catania, Ferarrotto Hospital, Via Citelli 95124, Catania, Italy. Tel.: +39 0957435980; fax: +39 095306833. (Email: calafiore{at}unich.it).

Background: The purpose of this study was to evaluate the impact of untreated moderate-or-more functional tricuspid regurgitation (FTR) on mid-term outcome of patients with functional mitral regurgitation (FMR) undergoing mitral valve surgery (MVS). Methods: From January 1988 to April 2003, 165 patients having FMR underwent MVS with untreated FTR. Patients with organic mitral or tricuspid valve disease were excluded. The entire population was divided into two groups, group A: 102 patients (FTR 0/1+), group B: 63 patients (FTR 2+/3+). No statistical difference was found between two groups concerning preoperative and operative variables. MV was repaired in 137 and replaced in 28 cases; the impact of untreated moderate-or-more FTR was estimated by Cox analysis. Results: Thirty-day mortality was 6.7 (5.9% group A vs 7.9% group B, p = 0.607). Five-year actuarial survival was 73.5% (66.6–80.4%); 88.2% (83.0–93.4%) group A versus 46.0% (33.7–58.3%) group B, p < 0.001; the possibility to be alive in NYHA class I–II was 65.8% (58.4–73.2%); 78.4% (72.3–84.5%) group A versus 41.2% (29.1–53.3%) group B, p < 0.001. Cox analysis confirmed the impact of untreated moderate-or-more FTR on 5-year survival (HR = 3.1, 95% CI = 1.8–5.1, p < 0.001) and possibility to be alive in NYHA class I–II (HR = 3.0, 95% CI = 1.8–4.9, p < 0.001). After a median interval time of 28 months (IQR = 11–60), TR grade was echocardiographically assessed in 122 (79.2%) of 154 patients surviving the first month. In group A (87 patients), TR grade decreased significantly from 0.7 ± 0.5 to 0.3 ± 0.5 (p < 0.001) in the early postoperative period. Then, it increased again to 0.6 ± 0.7 at follow-up (p < 0.001); no difference was found between preoperative and follow-up time (p = ns). In group B (35 cases), TR grade decreased significantly from 2.2 ± 0.4 to 1.3 ± 0.7 in the early postoperative period (p < 0.001), but then increased again to 2.2 ± 0.9 (p < 0.001 vs postoperative value; p = 0.838 vs preoperative value). Cox analysis confirmed that the progression of TR grade at follow-up is a risk factor for lower survival and possibility to be alive in NYHA class I–II. Conclusions: Patients with untreated moderate-or-more FTR had survival and survival in NYHA class I–II lower than patients with untreated less-than-moderate FTR at 5-year follow-up.

Key Words: Functional tricuspid regurgitation • Functional mitral regurgitation • Mitral valve surgery