Author + information
- Andreas Kammerlander,
- Beatrice Marzluf,
- Diana Bonderman,
- Mariam Nikfardjam,
- Alexandra Graf,
- Gerald Maurer and
- Julia Mascherbauer
Significant tricuspid regurgitation (TR) occurring late after left–heart valve surgery is frequent and associated with decreased exercise tolerance and quality of life. Re–operative tricuspid valve (TV) surgery has been reported to result in early mortality rates as high as 10% to 25%. The aim of the study was to evaluate whether significant TR late after left–heart valve surgery impacts on prognosis.
602 consecutive patients after successful surgery of the aortic or/and the mitral valve (49±29 months post–surgery) were prospectively followed for 5 years. The severity of TR was assessed by echocardiography. Significant TR was defined as TR ≥ moderate. The primary endpoint was defined as cardiovascular death. Cox regression was used to determine the impact of TR on survival.
Significant TR was present in 122 (20.3%) patients, who were predominantly female (66% vs. 49%, p<0.001), had a higher EuroSCORE (9.8±2.5 vs. 8.9±2.3, p<0.001) and had more previous cardiac surgeries (1.2±0.5 vs. 1.1±0.3, p=0.010). They more often had atrial fibrillation (48% vs. 19%, p<0.001) and were more symptomatic (NYHA≥II 55% vs. 31% p<0.001). Patients with significant TR had larger right ventricles (36.9±7.9mm vs. 32.7±5.0mm, p<0.001), more dilated left and right atria (66.7±13.0mm vs. 57.9±8.3mm and 65.0±13.1mm vs. 55.3±7.5mm; both p<0.001) and presented with worse left ventricular function (LVEF<50%: 19% vs.11%; p=0,020). In total, 132 (21.9%) patients died during follow–up (36.1% with significant TR vs. 18.3% without; p<0.001). 76 (12.6%) patients died of cardiovascular causes (26.2% vs. 9.2%, p<0.001). By Kaplan–Meier analysis, overall survival was significantly worse in patients with significant TR (1–,3– and 5–year survival 91.8%, 81.2% and 63.9% vs. 96.0%, 89.0% and 81.7%; log rank p<0.001). By multivariable Cox regression analysis, age (p<0.001), left atrial enlargement (p=0.004), coronary artery disease (p=0.001) and significant TR (p=0.028) were found to independently predict both overall and cardiovascular mortality.
Significant TR late after left–sided valve surgery is frequent and independently predicts mortality.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Valvular Heart Disease: Clinical VI – Prosthetic Valve
Abstract Category: 31. Valvular Heart Disease: Clinical
Presentation Number: 1241–79
- 2013 American College of Cardiology Foundation