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Late tricuspid regurgitation and right ventricular remodeling after tricuspid annuloplasty
Author(s) -
Calafiore Antonio M.,
Lorusso Roberto,
Kheirallah Hatim,
Alsaied Mojtaba Mohammed,
Alfonso Juan J.,
Di Baldassarre Angela,
Gallina Sabina,
Gaudino Mario,
Di Mauro Michele
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14840
Subject(s) - medicine , cardiology , ventricular remodeling , tricuspid valve , ventricle , regurgitation (circulation) , atrial fibrillation , tricuspid valve insufficiency , hazard ratio , mitral regurgitation , pulmonary hypertension , heart failure , surgery , confidence interval
Background The aim of the present retrospective study was to evaluate the influence of preoperative right ventricular (RV) and tricuspid valve (TV) remodeling on the fate of tricuspid annuloplasty (TA) and right ventricle. Methods From May 2009 to December 2015, 423 patients who had undergone TA for functional tricuspid regurgitation (TR) were included in the study. Residual and recurrent TR were defined as moderate or more TR at discharge and follow‐up, respectively. RV remodeling was defined as RV dysfunction and/or dilation. Results Residual TR after TA was recorded in 54 patients (13%). Five‐year freedom from TR recurrence was 81% ± 3% in patients without residual TR and 41 ± 8 in patients with residual TR ( P < .001). In patients without residual TR, the following risk factors for recurrent TR and late RV remodeling were identified: preoperative systolic pulmonary artery pressure, preoperative RV remodeling, severe preoperative TR or less than severe TR but with TV apparatus remodeling, and etiology of mitral regurgitation. Cox analysis with time‐dependent variables confirmed TR recurrence (hazard ratio [HR]: 3.1) and late RV remodeling (HR: 6.5) as risk factors for lower survival. No protective effect of either flexible band or rigid ring TA compared with DeVega procedure was found. Similarly, preoperative atrial fibrillation and pacemaker dependency, late failure of mitral valve surgery did not affect the fate of TR. Conclusions Prophylactic TA should be encouraged among surgeons. TA at the time of left‐sided valve surgery should take into consideration not only annular size, but also tethering severity and RV remodeling.