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J Thorac Cardiovasc Surg 2008;136:1187-1192
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Impact of the Maze operation on the progression of mild functional tricuspid regurgitation

^a Department of Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
^b Department of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
^c Department of Preventive Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea

Received for publication December 13, 2007; revisions received July 13, 2008; accepted for publication August 5, 2008.

^_* Address for reprints: Hyun Song, MD, Department of Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 388-1 Poongnap2-dong, Songpa-gu, Seoul 138-736, South Korea. (Email: cs3580{at}amc.seoul.kr).

Objectives: In patients having mitral valve surgery, concomitant surgery for mild functional tricuspid regurgitation remains the subject of debate. This study examined the effect of Maze operation and tricuspid valve repair on postoperative functional tricuspid regurgitation progression.

Methods: The study retrospectively analyzed 250 patients (86 men, 164 women) with mild functional tricuspid regurgitation (grade 2) who had mitral valve surgery between January 1994 and July 2006. Based on follow-up data, patients were defined as either stable (n = 209, 83.6%) or aggravated (n = 41, 16.4%). Predictors for significant tricuspid regurgitation development were identified using Cox regression analysis.

Results: The mean follow-up time was 62.6 ± 39.8 months after surgery. Although most mitral valve procedures were successful, there was an increase in the incidence of significant functional tricuspid regurgitation overall from immediately postoperative to final assessment (5.2% to 16.4%, P < 0.01). Univariate analysis showed that old age, shorter aortic crossclamping time, and omission of Maze operation were associated with functional tricuspid regurgitation progression. Multivariate analysis showed that older age (adjusted hazard ratio, 1.05; 95% confidence interval, 1.02 to 1.08), a rheumatic etiology of the mitral valve disease (adjusted hazard ratio, 2.31; 95% confidence interval, 1.21 to 4.42), and no Maze operation (adjusted hazard ratio, 7.90; 95% confidence interval, 1.90 to 32.86) were independent predictors of mild functional tricuspid regurgitation progression. For the 168 patients with preoperative atrial fibrillation, Maze operation improved the tricuspid regurgitation–free survival significantly (P < .01) but tricuspid valve repair showed no significant difference.

Conclusions: Mild functional tricuspid regurgitation can progress postoperatively despite successful mitral valve surgery. Although tricuspid valve repairs alleviate progression of functional tricuspid regurgitation, concomitant Maze operation is a more powerful protective factor against mild functional tricuspid regurgitation progression.