Impact of the maze procedure and postoperative atrial fibrillation on progression of functional tricuspid regurgitation in patients undergoing degenerative mitral repair.

OBJECTIVES The aim of this study is to investigate the factors contributing to the progression of functional tricuspid regurgitation (TR) after mitral repair for degenerative mitral regurgitation (MR) in relation to pre and postoperative atrial fibrillation (AF) and performance of the maze procedure. METHODS We assessed 398 patients with less than moderate TR who did not undergo tricuspid valve repair at the time of isolated mitral valve repair for degenerative MR between January 1999 and January 2010. RESULTS Clinical follow-up was complete in 385 patients (96.7%) with a median follow-up of 48.3 months (range 0.13-148.5). During this time, there were 21 late deaths (5.5%) and 17 major complications (4.4%), including 11 reoperations for MR recurrence (2.9%). On late follow-up echocardiography performed on 395 patients (median 44.6 months, range 6.0-147.3), 34 (9.6%) experienced moderate or greater MR and 16 (4.5%) experienced moderate or greater TR. The 5-year freedom from moderate or greater MR and moderate or greater TR rates were 88.3 ± 2.1 and 95.3 ± 1.5%, respectively. Time-updated Cox regression analysis showed that male gender [hazard ratio (HR) 3.83, 95% confidence interval (CI) 1.28-11.40, P = 0.016], New York Heart Association functional class III or IV (HR 2.64, 95% CI 0.88-8.00, P = 0.085), preoperative AF without maze (HR 10.48, 95% CI 2.49-44.21, P = 0.001), and postoperative AF (HR 14.56, 95% CI 4.46-47.58, P < 0.001) were significant risk factors for postoperative moderate or greater TR. Of the 79 patients with preoperative AF, 68 (86.1%) underwent concomitant maze procedures. Of them, eight (11.8%) experienced late AF (>3 months) recurrence. Freedom from AF at 5 years after the concomitant maze procedure was 87.8 ± 4.6%. CONCLUSIONS Preoperative AF without the maze procedure and postoperative AF can contribute to the development of moderate or greater functional TR after mitral repair for degenerative MR.