Should moderate tricuspid regurgitation be repaired at the time of mitral surgery? Results from a large registry-based study

Figures

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  Moderate tricuspid regurgitation may be a risk factor for mortality after mitral valve surgery.

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  Figure 1. Survival by severity of tricuspid regurgitation (TR). Each symbol represents a death positioned on the vertical axis by the Kaplan-Meier estimator; vertical bars are confidence limits equivalent to 1 standard error (SE). Blue represents none/trivial TR (TR = 0); green, mild TR (TR = 1); orange, moderate TR (TR = 2).

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  Figure 2. Relationship of predicted mortality and preoperative tricuspid regurgitation (TR). The random forest partial-dependency plot shows the risk-adjusted estimate of the independent effect of preoperative TR on predicted mortality. Solid lines represent risk-adjusted estimates. Blue represents none/trivial TR (TR = 0); green, mild TR (TR = 1); orange, moderate TR (TR = 2).

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  Figure 3. Temporal trend in postoperative tricuspid regurgitation (TR) grade. Lines represent parametric estimates of percentage of patients (mean effect) for each postoperative TR grade. Dashed lines represent the entire cohort; solid lines, patients who died during follow-up. Blue indicates none/trivial TR (TR = 0); green, mild TR (TR = 1); red, moderate/severe TR (TR = 2+).

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  Figure 4. Temporal trend in postoperative tricuspid regurgitation (TR) grade in patients with moderate preoperative TR. Solid lines represent parametric estimates of percentage of patients (mean effect) in each postoperative TR grades after the surgery. Blue indicates none/trivial TR (TR = 0); green, mild TR (TR = 1); red, moderate/severe TR (TR = 2+).

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  Figure 5. Development of moderate/severe tricuspid regurgitation (TR) by severity of preoperative TR. Solid lines represent parametric estimates of the percentage of patients (mean effect) with moderate/severe postoperative TR. Blue indicates none/trivial preoperative TR (TR = 0); green, mild preoperative TR (TR = 1); orange, moderate preoperative TR (TR = 2+).

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  Figure E1. Temporal distribution of postoperative echocardiograms. The figure shows the number of echocardiograms performed at various postoperative timepoints.

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  Figure E2. Overall survival. Each symbol represents a death positioned on the vertical axis by the Kaplan-Meier estimator. Vertical bars indicate confidence limits equivalent to 1 standard error (SE).

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  Figure E3. Temporal trend in postoperative tricuspid grade after surgery by severity of preoperative tricuspid regurgitation (TR) and postoperative mitral regurgitation (MR). Solid lines represent parametric estimates of the percentage of patients (mean effect) with moderate/severe postoperative TR. The blue solid line represents no preoperative TR and no postoperative MR; green solid line, mild preoperative TR and no postoperative MR; orange solid line, moderate preoperative TR and no postoperative MR; blue short-dashed line, no preoperative TR and mild postoperative MR; green short-dashed line, mild preoperative TR and mild postoperative MR; orange short-dashed line, moderate preoperative TR and mild postoperative MR; blue long-dashed line, no preoperative TR and moderate postoperative MR; green long-dashed line, mild preoperative TR and moderate postoperative MR; orange long-dashed line, moderate preoperative TR and moderate postoperative MR.

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  Figure E4. Relationship of predicted mortality and left ventricular ejection fraction in patients with preoperative moderate tricuspid regurgitation. The random forest partial-dependency plot shows the risk-adjusted estimates of the independent effect of left ventricular ejection fraction on predicted mortality. Dots and the solid line represent risk-adjusted estimates. Blue indicates survival at 1 year; green, survival at 5 years; orange, survival at 10 years; red, survival at 14 years.

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  Figure E5. Relationship of predicted mortality and preoperative right ventricular systolic pressure (pRVSP, mm Hg) in patients with preoperative moderate tricuspid regurgitation (TR). The random forest partial-dependency plot shows the risk-adjusted estimate of the independent effect of pRVSP on predicted mortality. Dots and the solid line represent risk-adjusted estimates. Blue indicates survival at 1 year; green, survival at 5 years; orange, survival at 10 years; red, survival at 14 years.