Background- Atrial fibrillation(AF) was reported as a predisposing factor for progression of tricuspid regurgitation(TR) in patients(Pts) with left-sided valve surgery(LSVS). We hypothesized that maze operation(MAZE) can prevent the progression of TR in these Pts. Methods- We analyzed 170 Pts(46±11 years), who were divided into 3 groups based on preoperative rhythm; GrI: 44 Pts with sinus rhythm, GrII: 48 with AF with MAZE, and GrIII: 78 with AF without MAZE. The decision whether or not to perform MAZE was made by surgeons' preference. Echocardiography was performed before, immediate after, and 92.2±17.2(range, 50-131) months after LSVS. Results- There were no differences in clinical and preoperative echocardiographic variables between GrII and GrIII. Significant TR at the final exam was present in 5 Pts of GrI(11.4%), 8 of GrII(16.7%), and 31 of GrIII(39.7%)(P=0.67 in GrI vs GrII, P<0.005 in GrI vs GrIII, and P=0.01 in GrII vs GrIII). Insignificant TR at the immediate postoperative exam was aggravated in 9.8% of GrI(4/41), 13.0% of GrII(6/46), and 38.8% of GrIII(26/67) at the final exam(P=0.89 in GrI vs GrII, P=0.002 in GrI vs GrIII, and P=0.006 in GrII vs GrIII). By multivariate analysis, the only factor preventing TR progression was the group factor, i.e. GrI or GrII vs GrIII, P<0.001 & =0.002, respectively. Four Pts underwent reoperation for severe TR during follow-up, all of whom were in GrIII. Conclusions- AF predisposes the Pts undergoing LSVS to progression of TR, which can be prevented by MAZE through the restoration of sinus rhythm.
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