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The Factors Affecting Long Term Tricuspid Regurgitation After Double Valve Replacement


      Background: This study aims to determine the hemodynamic performance of double valve prostheses and its effects on long term outcomes of tricuspid regurgitation(TR) following double valve replacement (DVR). Methods: Between January 2014- September 2017, all patients undergoing concomitant aortic and mitral valve replacement with or without concomitant tricuspid valve repair at the same center were reviewed. All patients were divided into three groups according to interventions tricuspid valve(TVI), that is no-tricuspid annuloplasty(TAP), tricuspid ring annuloplasty and tricuspid de-vega annuloplasty (TDVA).Results: The study included 179 patients, of whom 52% were women(with mean age 51.7±13.7 years). Of 179 patients, 100 were in the no-TAP group, 39 were in the ring annuloplasty group and 40 were in the TDVA group. There was no statically significant difference among the groups with regard to potential complications, in-hospital mortality and the survival rates. The degree of TR decreased with TVI. The rates of moderate and severe TR were significantly lower in in the ring annuloplasty group (P = 0.04 and 0.004). Female gender (OR = 4.0, 95%CI: 1.0-15.5, p = 0.05) and preoperative TR degree(OR = 2.9, 95%CI: 1.1-7.3, p = 0.01) were an independent predictors for the development of postoperative severe TR. Conclusion: Although the degree of postoperative TR varies according to whether to perform a TVI, DVR can be safe due to low operative mortality independently from TVI. The rates of moderate and severe TR were significantly lower in the ring annuloplasty group and female gender was an independent risk factor of TR progression.