Predictive factor of secondary tricuspid regurgitation after aortic valve replacement for aortic stenosis: the importance of myocardial hypertrophy and diastolic dysfunction

Gen Thorac Cardiovasc Surg. 2017 May;65(5):259-266. doi: 10.1007/s11748-017-0748-2. Epub 2017 Feb 26.

Abstract

Objectives: The aim of this study is to determine the predictors of secondary tricuspid regurgitation after aortic valve replacement for aortic stenosis.

Methods: Seventy-one patients, who underwent aortic valve replacement for aortic stenosis at our institute from January 2006 to July 2011, were divided into two groups: an STR group, which included 15 patients with moderate or greater than moderate secondary tricuspid regurgitation at a follow-up visit and a control group. Echocardiography was performed before surgery, at discharge, and at a late follow-up visit (mean follow-up 36 ± 19 months, range 0-77).

Results: Preoperatively, the number of women (p < .01), body surface area (p < .001), and relative wall thickness (0.60 ± 0.15 vs 0.71 ± 0.13, p = .022) showed significant differences between the two groups. At a follow-up visit, moderate or severe mitral regurgitation (p = .0001) and severe diastolic dysfunction (p = .003) showed significant differences between the two groups. In the Cox regression analysis, moderate or severe mitral regurgitation at follow-up (p = .038, hazard ratio 4.394, 95% CI 1.085-17.791) was the only independent predictor of secondary tricuspid regurgitation.

Conclusions: This study suggested that preoperative concentric myocardial hypertrophy and diastolic dysfunction were associated with development of the secondary tricuspid regurgitation at late follow-up.

Keywords: Aortic stenosis; Aortic valve replacement; Concentric myocardial hypertrophy; Diastolic dysfunction; Secondary tricuspid regurgitation.

MeSH terms

  • Aged
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Diastole
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis*
  • Humans
  • Hypertrophy, Left Ventricular / complications*
  • Hypertrophy, Left Ventricular / diagnosis
  • Hypertrophy, Left Ventricular / physiopathology
  • Male
  • Prognosis
  • Retrospective Studies
  • Time Factors
  • Tricuspid Valve Insufficiency / diagnosis
  • Tricuspid Valve Insufficiency / etiology*
  • Tricuspid Valve Insufficiency / physiopathology
  • Ventricular Dysfunction, Left / complications*
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left / physiology*