Impact of tricuspid regurgitation after redo valvular surgery on survival in patients with previous mitral valve replacement.

OBJECTIVE

The impact on survival of tricuspid regurgitation (TR) after redo valvular surgery in patients with previous mitral valve replacement (MVR) is unclear.

METHODS

We retrospectively analyzed 118 consecutive patients undergoing redo valvular surgery after MVR over a 20-year period. We determined the impact of TR after redo valvular surgery on survival and clinical factors that were associated with TR of 2+ or higher. The mean follow-up period was 7.1±6.5 years.

RESULTS

Overall hospital mortality was 8.5% (10 of 118). Logistic regression analysis revealed that cardiopulmonary bypass duration (odds ratio, 1.025; P=.0270) was an independent risk factor for hospital death. There were 25 late deaths. Survival after 5, 10, and 15 years was 77.5%±4.2%, 68.5%±5.1%, and 58.8%±6.3%, respectively. Multivariate Cox regression analysis showed that TR less than 2+ at discharge was a predictor of late survival (hazard ratio, 0.043; P<.0382), whereas age, female sex, left ventricular end-diastolic dimension, and cardiopulmonary bypass duration were predictors of late death. Survival for patients with TR less than 2+ versus 2+ or higher after redo surgery were 91.4%±3.4% versus 59.5%±11.9% at 5 years and 81.1%±5.3% versus 52.1%±12.5% at 10 years, respectively (log-rank P=.0285). Logistic regression analysis indicated that preoperative TR (odds ratio, 3.718; P=.0044) and chronic obstructive pulmonary disease (odds ratio, 28.576; P=.0154) were independent risk factors for TR of 2+ or higher after redo surgery.

CONCLUSIONS

Survival in patients with TR of 2+ or higher after redo valvular surgery was poor. The results of this study suggest that it is important to maintain a postoperative TR less than 2+ to improve long-term survival.