SIGNIFICANT TRICUSPID REGURGITATION IS A MARKER FOR ADVERSE OUTCOME IN PATIENTS UNDERGOING PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY

Objectives. This study examined the association between the presence o f tricuspid regurgitation and immediate and late adverse outcomes in p atients undergoing balloon mitral valvuloplasty. Background. Significa nt tricuspid regurgitation has an adverse impact on morbidity and mort ality in patients undergoing mitral valve surgery for mitral stenosis. Methods. We studied 318 consecutive patients (mean [+/-SI] age 54 +/- 15 years) who underwent balloon mitral valvuloplasty and had color Do ppler echocardiographic studies before the procedure. Patients were cl assified into three groups: 221 with no or mild (69%), 60 with moderat e (19%) and 37 with severe (12%) tricuspid regurgitation. Clinical fol low-up ranged from 6 to 62 months. Results. Before mitral valvuloplast y, increasing degrees of tricuspid regurgitation were associated with a smaller initial mitral valve area (p < 0.05), higher echocardiograph ic score (p < 0.05), lower cardiac output (p < 0.01) and higher pulmon ary vascular resistance (p < 0.01). Although the initial success rate did not differ significantly between groups, patients with a higher de gree of tricuspid regurgitation had less optimal results, as reflected by a smaller absolute increase in mitral valve area (1.02 vs. 0.9 vs. 0.7 cm(2), p < 0.01). The estimated 4-year event-free survival rate ( freedom from death, mitral valve surgery, repeat valvuloplasty and hea rt failure) was lower for the group with severe tricuspid regurgitatio n (68% vs. 58% vs. 35%, p < 0.0001). At 4 years, 94% of patients with mild tricuspid regurgitation were alive compared with 90% and 69%, res pectively, of patients with moderate or severe tricuspid regurgitation (p < 0.0001). Cox proportional analysis identified tricuspid regurgit ation as an independent predictor of late outcome (p < 0.001). Conclus ions. Patients with mitral stenosis and severe tricuspid regurgitation undergoing mitral valvuloplasty have advanced mitral valve and pulmon ary vascular disease, suboptimal immediate results and poor late outco me.