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ȣ - 480504 205 |
| Tricuspid regurgitation late after mitral valve replacement for rheumatic mitral valve disease |
| Cardiovascular Center, Research Institute, Yonsei University College of Medicine, Seoul, Korea |
| 문재연, 심지영, 하종원, 장병철, 임세중, 장양수, 정남식, 심원흠, 조승연, 김성순 |
Background: Severe tricuspid regurgitation (TR) may develop late after mitral valve replacement in the absence of prosthetic mitral valve dysfunction and other causes of left heart failure. The aim of this study was to investigate the incidence and long-term prognosis of severe TR late after mitral valve surgery with or without tricuspid annuloplasty (TAP) for rheumatic mitral valve disease.Method: From 309 patients who underwent mitral valve replacement (MVR) between 1995 and 1997 at Yonsei Cardiovascular Hospital, we selected 193 patients (52 men, 141 female; mean age 48±11) who underwent MVR for rheumatic valvular disease (TAP group: 56, No TAP group: 137). The mean follow up period was 83.2± 26.4 (range 3 to 114) months. Primary end points were time to clinical outcomes, such as death, reoperation for tricuspid valve, admission due to heart failure and the development of severe TR (grade III~IV/IV) without left side heart failure. Secondary end points were time to death from any cause. Patients classified into three groups: patients with coexisting mild TR (Grade 0, trivial, I), with moderate TR (Grade II) and with severe TR(Grade III-IV) at the time of initial mitral valve surgery.Result: Twenty-one patients (10.9%) developed clinical events [Mild TR group 6/121 (5.0%), moderate TR group 4/33 (12.1%), severe TR group 11/33 (28.2%)] during follow up periods. Of theses, 3 patients died from right heart failure at 23 to 27 months after severe TR was diagnosed. One patient had redo-TAP, and others had medical treatments. Event free survival rate differed significantly over the follow-up period between three groups (p=0.0001). By Cox regression analysis, initial severe TR (Hazard Ratio: 5.2, 95%CI 2.2-12.3), old age (Hazard Ratio: 4.3, 95%CI 1.4-12.8), TAP (Hazard Ratio: 4.3, 95%CI 1.8-10.5) were the risk factor for the development of late severe TR in MVR patients. Conclusion: The incidence of severe TR or right heart failure in the absence of prosthetic mitral valve dysfunction was 10.9% in MVR patients. Despite successful TAP, the severity of TR at the time of mitral valve surgery was the most important factor for prediction of late severe TR after operation.
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