{
  "abstract": "Background Secondary tricuspid regurgitation (TR) often develops or persists following left-sided valve surgery. However, its impact on outcomes and the optimal timing of intervention is unclear. This study examined the association between isolated postoperative secondary TR and outcomes in patients with a history of mitral or aortic valve surgery.Methods This observational single-centre cohort study included patients with left-sided valve surgery and less than moderate preoperative TR who underwent follow-up echocardiography between 2002 and 2024. The presence of isolated postoperative secondary TR was evaluated in relation to clinical outcomes. The primary endpoint was a composite of all-cause death and heart failure hospitalisations (HFH).Results The cohort consisted of 2487 patients with a mean age of 68 years and a median follow-up time of 3 years. All-cause mortality and HFH increased with the grade of postoperative TR (p<0.001). Postoperative TR was associated with the composite endpoint independent of cardiovascular risk factors and baseline comorbidities (adjusted HR 1.29; 95% CI 1.18 to 1.41; p<0.001). The association between postoperative TR and the primary endpoint remained significant after adjustment for right ventricular (RV) remodelling and moderate mitral regurgitation (adjusted HR 1.40; 95% CI 1.28 to 1.53; p<0.001). An increase in TR by at least two grades from the preoperative assessment was observed in 12.5% of patients and was associated with the composite endpoint (p<0.001). Age, sex, myocardial infarction, coronary artery bypass grafting, atrial fibrillation and RV remodelling were factors associated with TR progression (p<0.01).Conclusions In patients following left-sided valve surgery, isolated postoperative secondary TR is independently associated with mortality and HFH independent of RV size, function and baseline comorbidities. An increase in TR severity by at least two grades from the preoperative assessment is associated with adverse outcomes.",
  "authors": [
    {
      "affiliations": [
        "Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Mihaela Ioana Dregoesc"
    },
    {
      "affiliations": [
        "Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Evin Yucel"
    },
    {
      "affiliations": [
        "Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Jacob Dal-Bianco"
    },
    {
      "affiliations": [
        "Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Shani Dahan"
    },
    {
      "affiliations": [
        "Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Xin Zeng"
    },
    {
      "affiliations": [
        "Department of Heart Disease, Haukeland University Hospital, Bergen, Norway"
      ],
      "name": "Dana Cramariuc"
    },
    {
      "affiliations": [
        "Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Dhaval Kolte"
    },
    {
      "affiliations": [
        "Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Ignacio Inglessis-Azuaje"
    },
    {
      "affiliations": [
        "Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Jonathan J Passeri"
    },
    {
      "affiliations": [
        "Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Jacqueline Danik"
    },
    {
      "affiliations": [
        "Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Asishana Avo Osho"
    },
    {
      "affiliations": [
        "Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Antonia Kreso"
    },
    {
      "affiliations": [
        "Division of Cardiology, Baylor Scott and White Health Heart Hospital Plano, Plano, Texas, USA"
      ],
      "name": "Paul A Grayburn"
    },
    {
      "affiliations": [
        "Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Judy W Hung"
    }
  ],
  "title": "Isolated secondary tricuspid regurgitation after left-sided valve surgery: impact on clinical outcomes",
  "uid": "33acc7a5-82ab-54af-a880-34096781ce49"
}