Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Incidence of and Risk Factors for the Development of Significant Tricuspid Regurgitation after Isolated Aortic Valve Replacement

  • Minsang Kang (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Jae Woong Choi (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Suk Ho Sohn (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Ho Young Hwang (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Kyung Hwan Kim (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital)
  • Received : 2022.12.05
  • Accepted : 2023.04.19
  • Published : 2023.09.05
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Abstract

Background: The late progression of tricuspid regurgitation (TR) after mitral valve surgery is well known. However, few reports have described the progression of TR after aortic valve surgery. We investigated the incidence of and risk factors for the development of significant TR after isolated aortic valve replacement (AVR). Methods: This study analyzed patients with less than moderate TR who underwent isolated AVR at Seoul National University Hospital from January 1990 to December 2018. Significant TR was defined as moderate or higher. Echocardiographic follow-up was performed in all patients. The Fine-Gray model was used to identify clinical risk factors for the development of significant TR. Results: In total, 583 patients (61.7±14.2 years old) were included. Operative mortality occurred in 9 patients (1.5%), and the overall survival rates at 10, 20, and 25 years were 91.1%, 83.2%, and 78.9%, respectively. Sixteen patients (2.7%) developed significant TR during the follow-up period (13 moderate; 3 severe). The cumulative incidence of significant TR at 10, 20, and 25 years was 0.77%, 3.83%, and 6.42%, respectively. No patients underwent reoperation or reintervention of the tricuspid valve. Hemodialysis or peritoneal dialysis for chronic kidney disease (hazard ratio [HR], 5.188; 95% confidence interval [CI], 1.154-23.322) and preoperative mild TR (HR, 5.919; 95% CI, 2.059-17.017) were associated with the development of significant TR in the multivariable analysis. Conclusion: TR progression after isolated AVR in patients with less than moderate TR is rare. Preoperative mild TR and hemodialysis or peritoneal dialysis for chronic kidney disease were significant risk factors for the development of TR.

Keywords

Acknowledgement

We wish to thank the Medical Research Collaborating Center, Seoul National University Hospital, for statistical consultation.

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