Abstract 20398: Residual and/or Progression of Tricuspid Regurgitation; An Important Determinant of Long-Term Outcome Post-Aortic Valve Replacement for Severe Aortic Valve Stenosis
Introduction: Although residual tricuspid regurgitation (TR) is known to be associated with poor outcome post-mitral valve surgery, impact of residual TR on outcome post-aortic valve surgery is poorly understood. The aim of this study was to investigate the change of TR and the impact of preoperative TR on the late outcome after the isolated AVR for aortic valve stenosis (AS).
Methods: We reviewed an institutional series of 246 patients who underwent isolated aortic valve replacement (AVR) for severe AS between 2002 and 2013. By excluding 68 patients preoperatively having moderate or more mitral regurgitation (MR), 178 patients were enrolled in this study. The cohort was assigned into the 2 groups according to preoperative TR grade; TR group (mild or more, n=47) and non-TR group (trace or absent TR, n=131). The cohort was echocardiographically followed-up for 3.5±2.5 years postoperatively.
Results: There was no significant difference in the early outcomes, including 30-day mortality between the 2 groups. Survival post-AVR was not significantly different between the 2 groups, while freedom from heart failure was significantly lower in the TR group compared to the non-TR group, as analyzed by Kaplan-Meier method and log rank test (P=0.02). Survival and freedom from heart failure at 8 years were 81.3% and 64.8% in the TR group, respectively, while those in the non-TR group were 88.3% (p=0.27) and 66.1% (p=0.02), respectively. At the latest follow-up, 11 patients (28%) of the TR group and 7 patients (7%) of the non-TR group displayed moderate or more TR. The 18 patients having moderate or more TR at the latest follow up showed a higher rate of heart failure events than the remaining patients. Multivariate analysis by Cox proportional hazard model showed that preoperative pulmonary artery hypertension was a single independent predictor of development of moderate or greater TR in the late phase (odds ratio; 1.2, 95% confidence interval; 1.0-1.3, P <0.01).
Conclusions: Progression of TR was associated with poor clinical outcome post-AVR. Presence of preoperative pulmonary artery hypertension was an independent predictive factor of development of TR post-AVR, suggesting a rationale of concomitant tricuspid surgery for this population.
Author Disclosures: S. Yajima: None. K. Toda: None. S. Fukushima: None. T. Nakamura: None. S. Miyagawa: None. Y. Yoshikawa: None. S. Saito: None. K. Domae: None. T. Ueno: None. T. Kuratani: None. Y. Sawa: None.
- © 2016 by American Heart Association, Inc.