| 김미정, 이창훈, 정인현, 김상현, 송종민, 강덕현, 송현, 이재원, 송명근, 송재관 |
Background. Although atrial fibrillation (Af) in patients with mitral valvular heart disease (MVHD) was reported to be associated with development or persistence of significant tricuspid regurgitation (TR) after successful mitral valve replacement (MVR), the impact of maze operation (MAZE) needs to be elucidated. Methods. Total of 429 patients (253 women, Age 52±10yrs) who underwent MVR at Asan Medical Center from 1995 to 2004 were analyzed. Tricuspid repair and MAZE was also performed in 167 and 108 patients, respectively. Results. Among 429 patients, 146 patients (34%) showed significant TR (grade≥3/4) before MVR and 71 patients (17%) showed persistent significant TR at follow-up echocardiography (ECHO) (47±31 Mo after MVR). Sinus rhythm was maintained in 139 patients (32%). Patients with significant TR showed older age, higher prevalence of female gender, significant TR at preoperative ECHO, lower prevalence of MAZE, and higher peak systolic velocity of TR (TR Vmax) at preMVR and follow-up ECHO. Female gender (OR=2.7, 95% confidence interval [CI]=1.44–5.07, p=0.002), persistent Af (OR=7.2, 95%CI=2.76–18.63, p<0.001), and high TR Vmax after MVR (OR=4.69, 95%CI=2.37–9.28, p<0.001) were independent factors associated with persistent significant TR. Conclusions. In patients with MVHD and Af, concomitant MAZE at the time of MVR was effective to prevent significant TR after MVR and should be encouraged, especially in high risk factors including female gender and pulmonary hypertension before operation.
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