Predictors for Progression of Tricuspid Insufficiency Following Left-Sided Valvular Surgery: A Retrospective Cohort Study

Background: The operative indications for severe tricuspid insufficiencyin patients undergoing left-sided valvular surgery are well defined; however, for mild and moderate insufficiency, the findings are still controversial. In this study, we aimed to document the prognostic parameters for progression of tricuspid insufficiencyin patients undergoing left-sided valvular surgery. Methods: 135 patients undergoing mitral valve ± coronary bypass surgery were retrospectively examined. Patients with simultaneous tricuspid valvesurgery were excluded. Demographic, clinical, and laboratory findings were recorded and the relationship with progression of tricuspid insufficiencywas studied. Results: Valvular pathology was rheumatic in origin in 72.6% of patients. Tricuspid insufficiencywas progressed in 69 (51.1%) of patients, while it did not change in 66 (48.9%) patients. Echocardiographic parameters recorded during follow-up revealed that left ventricular end-diastolic diameter decreased, while there was no significant change in right ventricular end-diastolic diameter. Tricuspid insufficiencywas directly related with right ventricular end-diastolic diameter (P < .05), while no relationship was documented with left ventricular end-diastolic diameter. There was a statistically significant correlation between postoperative progression of tricuspid insufficiencyand left atrial diameter; however, no relationship was documented with age, sex, valvular disease etiology, comorbidities, or preoperative atrial fibrillation. Risk factor analysis revealed that left atrial diameter was the only prognostic factor. Conclusion: The indications for mild and moderate tricuspid insufficiencyare still not clear for patients undergoing left-sided valvular surgery. In this study, we documented that left atrial dilatation was a prognostic factor for progression of postoperative tricuspid insufficiency. In this group of patients, presence of left atrial dilatation may be an indication for tricuspid valveintervention.