Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty
Background—Patients who undergo tricuspid annuloplasty (TA) during left heart valve surgery have a poor postoperative clinical outcome. Nonetheless, preoperative right ventricular (RV) echocardiography parameters that predict adverse events in these patients are poorly understood.
Methods and Results—We studied 74 patients (age 58±10 years; men 27%) with significant tricuspid regurgitation who consequently underwent TA during left heart valve surgery. A total of 26 adverse events (22 heart failure and 4 cardiovascular deaths) occurred during a median follow-up of 26 months. RV mid-cavity diameter (Hazard Ratio [HR]=2.44, Confidence Interval [CI]=1.48 - 4.02, P<0.01), RV longitudinal dimension (HR=1.64, CI=1.10-2.45, P=0.02) and tricuspid valve (TV) tethering area (HR=3.25, CI=1.71 - 6.19, P<0.01) were independently associated with adverse events after adjustment with age and New York Heart Association class III/IV. Receiver-operator characteristic curve demonstrated that RV mid-cavity diameter (area under curve [AUC]=0.74, P<0.01) and TV tethering area (AUC=0.70, P=0.04) were most associated with adverse events at 1 year follow-up. The presence of either a large RV mid-cavity diameter or TV tethering area was predictive of adverse outcome at one year following TA.
Conclusions—The present study demonstrates that RV geometry dimension, namely RV mid-cavity diameter, and TV tethering area are important preoperative measures associated with adverse events in patients undergoing TA.
- Received May 14, 2013.
- Revision received August 28, 2013.
- Accepted September 16, 2013.