Right Ventricular Dysfunction, But Not Tricuspid Regurgitation, Is Associated With Outcome Late After Left Heart Valve Procedure

BACKGROUND Significant tricuspid regurgitation (TR) late after left heart valve procedure is frequent and associated with increased morbidity. Surgical correction carries a significant mortality risk, whereas the impact of TR on survival in these patients is unclear. OBJECTIVES This study sought to assess the impact of significant TR late after left heart valve procedure. METHODS A total of 539 consecutive patients with previous left heart valve procedure (time interval from valve procedure to enrollment 50 +/- 30 months) were prospectively followed for 53 +/- 15 months. RESULTS Significant TR (defined as moderate or greater severity by echocardiography) was present in 91 (17%) patients (65% female). Patients with TR presented with more symptoms (New York Heart Association functional class >= II 55% vs. 31%), lower glomerular filtration rates (61 +/- 19 ml/ min vs. 68 +/- 18 ml/ min), and a higher likelihood of atrial fibrillation (41% vs. 20%), all statistically significant. Right ventricular (RV) systolic function was worse in patients with significant TR (RV fractional area change 43 +/- 11% vs. 47 +/- 9%, p < 0.001). A total of 117 (22%) patients died during follow-up. By Kaplan-Meier analysis, overall survival was significantly worse in patients with significant TR (log-rank p < 0.001). However, by multivariable Cox analysis, only RV fractional area change, age, left atrial size, diabetes, and previous coronary artery bypass graft procedure were significantly associated with mortality, but not tricuspid regurgitation. CONCLUSIONS RV dysfunction, but not significant TR, is independently associated with survival late after left heart valve procedure. (C) 2014 by the American College of Cardiology Foundation.