Moderate Tricuspid Regurgitation With Left-Sided Degenerative Heart Valve Disease: To Repair or Not to Repair? Jose L. Navia, MD, Nicolas A. Brozzi,

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Moderate Tricuspid Regurgitation With Left-Sided Degenerative Heart Valve Disease: To Repair or Not to Repair? Jose L. Navia, MD, Nicolas A. Brozzi, MD, Allan L. Klein, MD, Lee Fong Ling, MBBS, Chanapong Kittayarak, MD, Edward R. Nowicki, MD, MS, Lillian H. Batizy, MS, Jiansheng Zhong, MS, Eugene H. Blackstone, MD The Annals of Thoracic Surgery Volume 93, Issue 1, Pages 59-69 (January 2012) DOI: 10.1016/j.athoracsur.2011.08.037 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Propensity score distribution and results of propensity score matching. (A) Mirrored histogram of distribution of propensity scores. No tricuspid valve (TV) repair group appears above the horizontal line of zero and tricuspid valve repair group below it. Dark bars indicate distribution of propensity scores of matched patients. (B) Covariate balance for selected variables before matching (filled triangles) and after matching (filled squares). Values on the horizontal axis represent the percent standardized difference [1] between tricuspid valve repair and no-repair groups. Data from Austin and Mamdani [29]. (AV = atrial valve; MV = mitral valve; RV = right ventricular.) The Annals of Thoracic Surgery 2012 93, 59-69DOI: (10.1016/j.athoracsur.2011.08.037) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Bubble plot of predischarge grade of tricuspid regurgitation (TR) compared with preoperative level 2+ among propensity-matched patients stratified by undergoing tricuspid valve (TV) repair or not. The Annals of Thoracic Surgery 2012 93, 59-69DOI: (10.1016/j.athoracsur.2011.08.037) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Percent of propensity-matched patients in each grade of tricuspid valve (TV) regurgitation (TR) postoperatively: (A) TR 0; (B) TR 1+; (C) TR 2+; (D) TR 3+/4+. Horizontal lines are point estimates enclosed within dashed 68% confidence bands. These have been adjusted for repeated measures. Symbols represent data grouped (without regard to repeated measurements) within time frames to provide a crude verification of model fit. The Annals of Thoracic Surgery 2012 93, 59-69DOI: (10.1016/j.athoracsur.2011.08.037) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Percent of propensity-matched patients in each New York Heart Association (NYHA) functional class, depicted from operation to 6 years postoperatively: (A) NYHA class I; (B) NYHA class II; (C) NYHA class III; (D) NYHA class IV (depiction is as in Figure 3). (TR = tricuspid regurgitation; TV = tricuspid valve.) The Annals of Thoracic Surgery 2012 93, 59-69DOI: (10.1016/j.athoracsur.2011.08.037) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Survival of propensity-matched patients with or without a tricuspid valve (TV) repair. Each symbol represents a death, vertical bars 68% confidence limits, and numbers in parentheses patients remaining at risk. Solid lines enclosed within dashed 68% confidence bands are parametric survival estimates. The Annals of Thoracic Surgery 2012 93, 59-69DOI: (10.1016/j.athoracsur.2011.08.037) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions