Determinants of Late Tricuspid Regurgitation After Aortic-Mitral Double Valve Replacement

The aims of this study are to evaluate the long-term outcomes of double valve replacement (aortic and mitral valves) and to investigate the determinants of late tricuspid regurgitation (TR). A total of 239 consecutive patients who underwent double valve replacement were enrolled. Valve pathology was rheumatic in 86.6% (207/239) and degenerative in 13.4% (32/239) of patients. Among these patients, 116 patients underwent concomitant tricuspid annuloplasty, and follow-up was completed for all 239 patients (mean = 7.3 ± 4.1, maximum = 15.9 years). We used propensity score matching to match 67 patients without tricuspid annuloplasty to the 114 patients who underwent annuloplasty. There was 1 in-hospital death and 9.7% (23/238) of patients experienced late cardiac-related mortality. Analysis of aortic valves indicated that the transprosthetic mean pressure gradient increased with time (13.4 ± 5.2 vs 15.4 ± 9.0 mm Hg, p = 0.002). Aortic transprosthetic mean pressure gradient increased more notably in woman and was associated with late TR (odds ratio 1.1, p = 0.010). In patients with mild TR, those who underwent tricuspid valve repair were less likely to experience a cardiac-related death within 10 years of surgery (hazards ratio 6.1, p = 0.036).