The relationship of atrial fibrillation and tricuspid annular dilation to late tricuspid regurgitation in patients with degenerative mitral repair

Abstract Objectives Guidelines do not address preoperative atrial fibrillation when considering adding tricuspid annuloplasty to mitral surgery. Our purpose was to determine the occurrence of late tricuspid regurgitation in patients with less than moderate tricuspid regurgitation undergoing degenerative mitral regurgitation surgery, and the importance of atrial fibrillation and tricuspid annular dilation. Methods From 2004-2017, 1021 patients had surgery for degenerative mitral regurgitation; 869 (85%) had less than moderate tricuspid regurgitation and 846 (97%) had repair. Preoperative AF was present in 199 patients and ablated in 97% (194). Tricuspid annular diameter was measured in 657/869 (76%). Results For patients who did not have tricuspid annuloplasty recurrent moderate or more late tricuspid regurgitation was 8% (45/576) in the No AF group vs. 25% (38/154) in the AF group (p Conclusions Preoperative atrial fibrillation is an important risk factor for late TR, despite concomitant ablation surgery. Tricuspid annular dilation was not associated with late TR until the annulus was 45mm or greater. Progression to moderate or greater TR was associated with an increase in late mortality.