Abstract 10699: Functional Tricuspid Regurgitation and Right Ventricular Remodeling and Dysfunction: Risk Factors for Prognosis after Degenerative Mitral Valve Disease Surgery?
Objective: To investigate whether the associated right ventricular (RV) remodeling and dysfunction are more important determinants of preoperative organ dysfunction and prognosis than functional tricuspid regurgitation (TR) in patients undergoing surgery for degenerative mitral valve (MV) disease.
Methods: From 1/2001 to 1/2011, 4,197 patients underwent primary MV surgery for degenerative MV disease. A quasi-experimental study design was used, with random selection of 781 patients: 200 each in TR grades 0, 1+, and 2+, and all 181 in TR grade 3-4+. Preoperative echocardiographic data on RV morphology and function were reassessed de novo on stored digital images. Multivariable linear regression was used to determine risk factors for renal (BUN and eGFR) and liver failure (MELD score), focusing particularly on RV morphology and function, and TR. There were 3,471 patient-years of follow-up available and 52 deaths; survival analysis used a multiphase hazard function model.
Results: Several right ventricular remodeling and dysfunction variables, but not degree of TR (P>0.05), were associated with preoperative renal and liver dysfunction (Table). Neither preoperative RV morphology and function nor degree of TR was associated with early mortality (P>0.05). However, higher preoperative myocardial performance index indicating RV dysfunction (P=0.001), but not greater degree of preoperative TR (P>0.2), was among risk factors for late mortality (>6 months after surgery).
Conclusion: Preoperative RV remodeling and dysfunction, rather than degree of TR, help explain preoperative organ dysfunction, and may determine the prognosis of patients undergoing MV surgery for degenerative MV disease.
- © 2012 by American Heart Association, Inc.