We sought to assess the evolution of secondary tricuspid regurgitation (TR) after isolated aortic valve replacement (AVR) and its impact on mortality and to identify possible clinical and echocardiographic predictors of persisting and new onset TR (TR de novo) after isolated AVR.

Clinical and echocardiographic data of 441 patients, consecutively operated for isolated AVR between January 2017 and January 2020, were retrospectively collected. Four time points were included: pre-operative, discharge, 3–6 months, and last available follow-up. We followed patients with at least moderate TR (TR ≥ 2) over time and monitored the impact on survival. Logistic regression analysis was performed to identify possible predictors of persistent TR and TR de novo.

Median follow-up was 33 months. Incidence of TR ≥ 2 changed over the time points. Twenty-three % of patients with preoperative TR ≥ 2 had persistent TR at 3–6 months follow-up, and this phenomenon was predicted by age at regression analysis. Preoperative TR ≥ 2 was associated with a 3-fold higher risk to die. At 3–6 months follow-up, 12% of patients developed TR de novo. At least moderate preoperative mitral regurgitation (MR ≥ 2) was predictive of TR de novo.

Patients with TR ≥ 2 undergoing isolated AVR had worse long-term survival, and this was particularly evident in the elderly. Older patients were also more prone to have persistent TR after AVR. Some patients developed TR de novo after isolated AVR, but this did not affect survival.