Risk factors for long-term severe tricuspid regurgitation following mitral valve replacement: a retrospective study

BACKGROUND: The aim of this study is to identify factors associated with the development of long-term severe tricuspid regurgitation (TR) following mitral valve replacement (MVR). METHODS: A retrospective analysis was conducted involving 308 patients who underwent single-valve MVR at Xuzhou Central Hospital between April 2017 and December 2022. Preoperative color Doppler ultrasound indicated that all patients had either no or mild to moderate tricuspid regurgitation. Postoperative follow-up was carried out over several years, and patients were categorized into two groups based on the severity of TR: 258 patients with non-severe TR (observation group) and 50 patients with severe TR (control group). Clinical data, medical history, the performance of tricuspid valvuloplasty during surgery, and echocardiographic parameters before and after the procedure were recorded. Comparative analysis between the two groups was performed, and logistic regression analysis was used to identify factors associated with the long-term development of severe TR post-MVR. RESULTS: Logistic regression analysis indicated that serum creatinine levels (OR = 1.023, P = 0.026), atrial fibrillation (OR = 2.780, P = 0.040), and a history of permanent pacemaker implantation (OR = 3.029, P = 0.039) were significantly associated with the development of severe TR over time. In contrast, concurrent intraoperative tricuspid valvuloplasty was associated with a reduced risk of TR (OR = 0.315, P = 0.002). CONCLUSIONS: Elevated serum creatinine, atrial fibrillation, and a history of permanent pacemaker implantation were positively associated with the long-term occurrence of severe TR following MVR. In contrast, concurrent intraoperative tricuspid valvuloplasty was found to reduce the likelihood of severe TR development.