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.