Surgical Outcome of Severe Tricuspid Valve Regurgitation Developed Long after Left-sided Valvular Surgeries

Background: Early surgical treatment for severe tricuspid regurgitation (TR) is recommended before right or left heart failure develops, however those who have developed severe TR late after left-sided valvular surgery are prone to be treated noninvasively because the risk of repeated surgery is concerned. Methods: Nine patients with severe symptomatic TR treated surgically in our hospital long after left-sided valvular disease were reviewed retrospectively. Results: Average age of the patients were 67 ± 4 years. Prior surgeries had been performed at their age of 37 ± 11 years, and heart failure symptoms had appeared 11 ± 8 years before subsequent surgeries. The second surgeries were performed with aortic valve replacement in 3, with mitral valve replacement in 4, and without left-sided valve surgery were in 2. None of the nine patients died perioperatively, however 4 patients died during a mean follow up period of 2.3 ± 1.7 years. Right heart catheterization was performed after surgery in 6 patients. Systolic regurgitant pressure of right atrium were prone to decrease (P = .66) and cardiac index increased significantly (P = .033), however mean pressure of right atrium and pulmonary artery wedge pressure increased considerably in some patients. Conclusion: Operative risk of surgical treatment for TR late after left-sided valvular surgery is not high, however long-term prognosis is poor with incomplete hemodynamic improvement in some patients.