Abstract 12402: Predictors of Late Improvement of Significant Remnant Tricuspid Regurgitation Detected Early after Tricuspid Annuloplasty
Background: In some patients with severe tricuspid regurgitation (TR) who undergo tricuspid annloplasty (TAP), remnant significant TR is detected early after TAP but diminishes after long-term follow-up. However, outcome of significant residual TR early after TAP and predictors for the late improvement of TR have not been demonstrated.
Methods: A total of 58 consecutive patients who presented moderate and severe TR early (5.7 ± 2.0 days) after TAP were enrolled. Clinical characteristics of patients and surgical procedures were evaluated, and echocardiographic parameters early after TAP were measured. Echocardiography was repeated for 31 ± 27 months after TAP, and improvement of TR was defined as ≤ mild TR.
Results: Thirty-five (60.3%) patients showed late improvement of TR at least once during follow-up. Multivariate recurrent event survival analysis revealed that large tricuspid valve (TV) tenting height measured early after TAP, and execution of Maze and right atrium reduction surgeries with TAP were independent parameters predicting late improvement of significant residual TR, whereas right ventricular areas were not (Table). Performance of aortic valve replacement with TAP was significantly associated with late persistent significant TR. Receiver-operating characteristic curve analysis showed that TV tenting height ≥ 9.0 mm early after TAP predicted late improvement of TR with a sensitivity of 74% and a specificity of 57%. In patients showing late improvement of TR, TV tenting height significantly decreased during early to late follow-up after TAP (10.7 ± 2.8 vs. 7.2 ± 2.0 mm, p<0.001), whereas it did not in others (9.1 ± 2.9 vs. 8.4 ± 3.0 mm, p=0.204).
Conclusions: More than a half of patients with a significant remnant TR early after TAP experienced late improvement of TR. Evaluation of combined surgical procedures and TV tenting height early after TAP help to identify patients for whom repeated TV surgery may be deferred.
- © 2012 by American Heart Association, Inc.