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Degree of right ventricular dysfunction dictates outcomes after tricuspid valve repair concomitant with left-side valve surgery

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Abstract

Objectives

The effect of different degrees of right ventricular (RV) dysfunction on long-term outcomes after tricuspid valve repair is the subject of ongoing research. We sought to evaluate the effect of preoperative RV dysfunction on mortality and recurrence of tricuspid regurgitation (TR) after tricuspid valve repair for secondary TR concomitant with left-side valve surgery.

Methods

This is a retrospective study, including 548 patients who underwent repair of secondary TR (2009–2017) at a single institution. Patients were grouped according to preoperative right ventricular (RV) systolic function into three groups; normal RV function (group 1, n = 451), mild RV dysfunction (group 2, n = 60) and moderate/severe RV dysfunction (group 3, n = 37). Study endpoints were mortality and recurrence of TR.

Results

Group 3 was associated with the highest hospital mortality (10.2%, p = .06). Predictors of moderate or higher grade TR were NYHA class (HR 2.1, p = 0.03); preoperative TR grade (HR 1.9, p < 0.01), mild RV dysfunction (HR 2.4, p < 0.01), isolated RV dilatation (HR 2.0, p < 0.01), and flexible TV repair prostheses (HR 2.4, p = 0.01). Predictors of mortality were renal impairment (HR 3.0, p < 0.01), ejection fraction (HR 0.97, p = 0.02), pulmonary artery systolic pressure (HR 1.02, p = 0.02), preoperative TR grade (HR 1.7, p < 0.01), and moderate/severe RV dysfunction (HR 3.1, p = 0.01).

Conclusion

Compared to normal and mild degree of RV dysfunction, moderate and severe RV dysfunction were independent predictors of poor long-term survival. Isolated RV dilatation increased the recurrence of TR. RV dysfunction and dilatation could be indications of tricuspid valve repair.

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References

  1. Kammerlander AA, Marzluf BA, Graf A, et al. Right ventricular dysfunction, but not tricuspid regurgitation, is associated with outcome late after left heart valve procedure. J Am Coll Cardiol. 2014;64:2633–42.

    Article  Google Scholar 

  2. Dietz MF, Prihadi EA, van der Bijl P, et al. Prognostic implications of right ventricular remodeling and function in patients with significant secondary tricuspid regurgitation. Circulation. 2019;140:836–45.

    Article  Google Scholar 

  3. Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation. 2009;119:2718–25.

    Article  Google Scholar 

  4. Nath J, Forster E, Heidenreich PA. Impact of tricuspid regurgitation on long term survival. J Am Coll Cardiol. 2004;34:405–9.

    Article  Google Scholar 

  5. Nishimura RA, Otto CM, Bonow RO, ACC/AHA Task Force Members, et al. 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:2440–92.

    Article  Google Scholar 

  6. Baumgartner H, Falk V, Bax JJ, ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91.

    Article  Google Scholar 

  7. Subbotina I, Girdauskas E, Bernhardt AM, Sinning C, Reichenspurner H, Sill B. Comparison of outcomes of tricuspid valve surgery in patients with reduced and normal right ventricular function. Thorac Cardiovasc Surg. 2017;65:617–25.

    Article  Google Scholar 

  8. Kwon DA, Park JS, Chang HJ, et al. Prediction of outcome in patients undergoing surgery for severe tricuspid regurgitation following mitral valve surgery and role of tricuspid annular systolic velocity. Am J Cardiol. 2006;98:659–61.

    Article  Google Scholar 

  9. Haddad F, Denault AY, Couture P, et al. Right ventricular myocardial performance index predicts perioperative mortality or circulatory failure in high-risk valvular surgery. J Am Soc Echocardiogr. 2007;20:1065–72.

    Article  Google Scholar 

  10. Bootsma IT, de Lange F, Koopmans M, et al. Right ventricular function after cardiac surgery is a strong independent predictor for long-term mortality. J Cardiothorac Vasc Anesth. 2017;31:1656–62.

    Article  Google Scholar 

  11. Lindman BR, Maniar HS, Jaber WA, et al. Effect of tricuspid regurgitation and the right heart on survival after transcatheter aortic valve replacement: insights from the placement of aortic transcatheter valves II inoperable cohort. Circ Cardiovasc Interv. 2015;8:e002073.

    Article  Google Scholar 

  12. Ling LF, Obuchowski NA, Rodriguez L, Popovic Z, Kwon D, Marwick TH. Accuracy and interobserver concordance of echocardiographic assessment of right ventricular size and systolic function: a quality control exercise. J Am Soc Echocardiogr. 2012;25:709–13.

    Article  Google Scholar 

  13. Schneider M, Aschauer S, Mascherbauer J, et al. Echocardiographic assessment of right ventricular func-tion: current clinical practice. Visual assessment of right ventricular function by echocardiography: how good are we? Int J Cardiovasc Imaging. 2018;35:49–56.

    Article  Google Scholar 

  14. Rudski LG, Lai WW, Afilalo J, et al. Guidelines for the echocardio-graphic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the Euro-pean Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685–713.

    Article  Google Scholar 

  15. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–70.

    Article  Google Scholar 

  16. Magunia H, Schmid E, Hilberath JN, et al. 2D Echocardiographic evaluation of right ventricular function correlates with 3D volumetric models in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2017;31:595–601.

    Article  Google Scholar 

  17. Vargas Abello LM, Klein AL, Marwick TH, et al. Understanding right ventricular dysfunction and functional tricuspid regurgitation accompanying mitral valve disease. J Thorac Cardiovasc Surg. 2013;145:1234–41.

    Article  Google Scholar 

  18. Dreyfus GD, Corbi PJ, Chan KM, Bahrami T. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg. 2005;79:127–32.

    Article  Google Scholar 

  19. Dreyfus GD, Martin RP, Chan KM, Dulguerov F, Alexandrescu C. Functional tricuspid regurgitation: a need to revise our understanding. J Am Coll Cardiol. 2015;65:2331–6.

    Article  Google Scholar 

  20. Chikwe J, Itagaki S, Anyanwu A, Adams DH. Impact of concomitant tricuspid annuloplasty on tricuspid regurgitation, right ventricular function, and pulmonary artery hypertension after repair of mitral valve prolapse. J Am Coll Cardiol. 2015;65:1931–8.

    Article  Google Scholar 

  21. Wang N, Phan S, Tian DH, Yan TD, Phan K. Flexible band versus rigid ring annuloplasty for tricuspid regurgitation: a systematic review and meta-analysis. Ann Cardiothorac Surg. 2017;6:194–203.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia

    Khaled D. Algarni & Turki B. Albacker

  2. Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia

    Khaled D. Algarni, Amr Arafat, Abdulaziz D. Algarni & Abdulaziz Alhossan

  3. Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt

    Amr Arafat

  4. Cardiac Research Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia

    Juan J. Alfonso

  5. Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia

    Abdelhameed Elsayed & Hatim M. Kheirallah

Authors
  1. Khaled D. Algarni
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  2. Amr Arafat
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  3. Abdulaziz D. Algarni
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  4. Juan J. Alfonso
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  5. Abdulaziz Alhossan
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  6. Abdelhameed Elsayed
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  7. Hatim M. Kheirallah
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  8. Turki B. Albacker
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Correspondence to Khaled D. Algarni.

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Algarni, K.D., Arafat, A., Algarni, A.D. et al. Degree of right ventricular dysfunction dictates outcomes after tricuspid valve repair concomitant with left-side valve surgery. Gen Thorac Cardiovasc Surg 69, 911–918 (2021). https://doi.org/10.1007/s11748-020-01536-7

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