Abstract 3456: Reversal of Severe Tricuspid Regurgitation after Pulmonary Endarterectomy is due to Right Ventricular Reverse Remodeling: Results of a Composite Study
Background: Severe functional tricuspid regurgitation (TR) is a hallmark of chronic thrombo-embolic pulmonary hypertension (CTEPH), yet little is known about the natural history of TR after relief from CTEPH. We sought to assess early- and late-term tricuspid function after pulmonary endarterectomy (PEA) and to associate it with the reversal of right ventricular (RV) morphological and functional changes induced by CTEPH.
Material and Methods: From December 2000 to March 2006, 90 patients underwent PEA. Type and grade of TR and end-diastolic eccentricity index were studied by echo. RV tele-diastolic and tele-systolic volumes and RV ejection fraction were measured by cardiac MR. Hemodynamic variables were obtained through right heart catheterization. Patients with a full set of pre-operative data (n=66) were studied pre-discharge, then at 3 months, 1 and 3 years post-operatively.
Results: After PEA, mortality rate was 4.5%. Hemodynamic recovery was immediate (Table⇓). TR dramatically improved and RV geometry almost normalized within the first few weeks post-operatively. RV systolic function fully recovered during the first post-operative year.
Conclusions: TR was always deemed functional. No surgical repair was performed. Yet, TR dramatically improved along with RV volume reduction and a change in RV chamber geometry. The presence, in a few patients, of secondary pulmonary arteriopathy due to long-standing pre-operative CTEPH accounts for the late slight increase in TR rate within a smaller cohort of individuals. In conclusion, after PEA the right ventricle rapidly reassumes normal size and shape, with resultant correction of TR, and without the need of adjunctive surgical procedures.