Tricuspid Annular Size and Regurgitation Progression After Surgical Repair for Degenerative Mitral Regurgitation

The late worsening of nonsevere tricuspid regurgitation (TR) after mitral valve surgery is a relevant clinical problem that can lead to high-risk reoperation. Although tricuspid annulus (TA) dilatation has been proposed for prophylactic annuloplasty to prevent TR worsening, prospective data in degenerative mitral regurgitation (MR) are lacking. The aim of this prospective cohort study was to evaluate TA dimension to predict TR progression after valve repair for degenerative MR. Clinical and echocardiographic evaluation of 706 patients with degenerative MR and no significant TR was obtained preoperatively and at follow-up after isolated mitral valve repair. Together with standard cardiac chamber and valve analysis, 3-dimensional (3D) transesophageal echocardiography was performed to evaluate TA, including the anteroposterior and septolateral diameters. After a mean follow-up of 24 ± 15 months (range 6 to 60), 2 patients died while 14 developed severe MR. Compared with preoperative values, TR decreased (≤1 degree) in 227 patients, was unchanged in 437, and increased (≥1 degree) in 39 patients, with the development of significant TR (3 to 4 degree) in 3 patients. Receiver-operating characteristic curve analysis did not identify significant TA values predicting postoperative TR worsening. On multivariate regression analysis, recurrent MR and pulmonary hypertension at follow-up emerged as significant positive predictors of TR progression. Newly developed significant TR is a rare event after successful repair of degenerative MR. Although more accurate than conventional 2D measurement, 3D analysis of TA does not predict early to midterm subsequent TR progression.