Incidence of Residual Tricuspid Regurgitation in Patients Undergoing Left-heart Surgery
Incidence of Residual Tricuspid Regurgitation in Patients Undergoing Left-heart Surgery
Functional tricuspid valve regurgitation is commonly co-existed with left-sided cardiac
 lesion, especially mitral valve stenosis. Both lesion were recommended to surgically fixed at
 the same setting. Residual tricuspid regurgitation may effects patients' outcome. The
 investigators would like to determine the incidence of significant residual tricuspid
 regurgitation after left-sided cardiac surgery and related clinical outcome.
Functional tricuspid regurgitation (TR) was defined as TR occurring secondary to left heart,
 especially mitral valve stenosis or pulmonary disease. Previous study reported that about 30%
 - 50% of patients with significant mitral stenosis developed moderate to severe TR. In the
 past, corrective TR repair was not always indicated because the concept about TR severity
 will improve after mitral valve lesion was treated.

 Later on, several studies demonstrated that the patients with untreated significant (<
 moderate) TR had worse clinical outcome including mortality. While simultaneous functional TR
 repair with left-sided valve surgery did not cause adverse events, but improve clinical
 outcome and quality of life. The current European Society of Cardiology (ESC)/European
 Association for Cardio-Thoracic Surgery (EACTS) and American Heart Association(AHA)/American
 College of Cardiology (ACC) guidelines recommend concomitant tricuspid valve (TV) surgery in
 patients with severe TR undergoing left-sided valve surgery (class I recommendation). In
 patients with mild to moderate TR, there is a class IIa indication for concomitant TV surgery
 in the setting of tricuspid annular dilatation.

 However, after TV repair, commonly with annuloplasty ring or De Vega annuloplasty, residual
 TR may still persist and the residual moderate or severe TR have negative impact to right
 ventricle (RV). It can cause RV dilatation and RV failure(7, 12). Calafiore et al reported
 12.4% of significant TR after surgery and the associated factors for the repair failure. If
 this group of patients developed symptom of RV failure or progressive RV dilatation or
 dysfunction is detected, they possessed very high-risk for re-operation.

 Preoperative transthoracic echocardiography (TTE) is an important tool to classified severity
 of TR, measured TV annulus, indicate the surgical correction requirement and demonstrate the
 result of the TR repair. Due to limitation of TTE operator and machine, time-interval between
 the latest preoperative TTE result and surgery are varied, so the TR severity may already
 changed. The postoperative TTE result sometimes comes out late after surgery. Therefore,
 transesophageal echocardiography (TEE), operated by trained cardiac anesthesiologist, may
 play role to confirm the severity and provide the instant result of the TV repair to help
 guide the cardiac surgeon to make a decision whether to re-operate in the same setting to
 improve the surgical outcome.

 Therefore, the investigators would like to determine the incidence of residual significant TR
 by intraoperative TEE in the patients underwent left-side cardiac surgery and the related
 clinical outcome, including rate of re-admission from cardiac cause and 1- year mortality.
Inclusion Criteria:

 -  Mitral valve or aortic valve diseases requiring surgical intervention

 -  No pathologic changes in TV leaflets

 -  No previous tricuspid valve surgery

 Exclusion Criteria:

 -  Patients with incomplete data

 -  Patient with history of previous cardiac surgery

 -  Patient with congenital anomalies of mitral or tricuspid valve

 -  Patient with both tricuspid stenosis and regurgitation