| 곽재진¹, 김민경¹ ,김형관¹ ,박진식¹ ,김용진¹ ,김기봉² ,손대원¹ ,안혁² ,오병희¹ ,박영배¹ ,최윤식¹ |
Background We investigated the incidence and risk factors of late tricuspid regurgitation (TR) in patients underwent mitral valve (MV) or aortic valve (AV) surgery. Methods A retrospective analysis was performed on 556 patients (263 male, 293 female; mean age 45±14 yr) underwent left-sided valve surgery between 1992 and 1995. The development of late TR was evaluated in the echocardiographic follow-up, which was performed at least 10 years after surgery. The significant TR was defined as more than mild degree. Results Among 556 patients, 287 patients (51%) had MV surgery, 115 patients (21%) had AV surgery, and 154 patients (28%) had combined MV and AV surgery. Among 399 patients who underwent follow-up echocardiography after surgery, the late TR was identified in 191 patients (34.3%) and occurred more frequently in MV surgery group (11% in AV, 40% in MV, and 43% in combined surgery, p<0.05). The late TR grou! p showed higher age (47.0±14.1 vs 43.4±13.6 yr, p<0.05), more female (62 vs 51.7%, p<0.05), lower height (160±7.9 vs 162±8.9 cm, p<0.05), more atrial fibrillation (84.6 vs 47.5%, p<0.01), higher left atrial dimension (58.7±12.3 vs 52.9±11.8 mm, p<0.01), higher pulmonary artery systolic pressure (47.4±19.7 vs 42.7±18.6 mmHg, p<0.05), higher right atrial pressure (11.8±9.3 vs 7.7±5.5 mmHg, p<0.01), more previous MV surgery (39.4 vs 23.7%, p<0.01), more preoperative significant TR (33.3 vs 10.3% p<0.01), and more rheumatic etiology (76.3 vs 56.4%, p<0.01). In multivariate logistic regression analysis, preoperative atrial fibrillation (OR 4.51; C.I. 2.16-9.60, p<0.01), combined MV and AV surgery (OR 4.65; C.I. 1.26-17.14, p=0.02) and right atrial pressure (OR 1.05; C.I. 1.01-1.10, p=0.02) were independent predictors in late TR. During follow up, 46 Patients (11.5%) developed severe TR and 17 patients underwent tricuspid valve surgery for isolated TR. The survival rate! was significantly lower in late TR group. Conclusions The late TR was common (34%) after left-sided valve surgery and associated with poor prognosis. Preoperative atrial fibrillation, combined MV and AV surgery, and high preoperative right atrial pressure were identified as independent predictors.
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