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. 2022 Jan 27:9:686208.
doi: 10.3389/fcvm.2022.686208. eCollection 2022.

Prevalence and Prognostic Importance of Massive Tricuspid Regurgitation in Patients Undergoing Tricuspid Annuloplasty With Concomitant Left-Sided Valve Surgery: A Study on Rheumatic Valvular Heart Disease

Yan Chen  1   2   3 , Yap-Hang Chan  3 , Mei-Zhen Wu  3 , Yu-Juan Yu  3 , Yui-Ming Lam  3 , Ko-Yung Sit  4 , Daniel Tai-Leung Chan  4 , Cally Ka-Lai Ho  4 , Lai-Ming Ho  5 , Chu-Pak Lau  3 , Wing-Kuk Au  4 , Hung-Fat Tse  3 , Kai-Hang Yiu  2   3
Affiliations

Prevalence and Prognostic Importance of Massive Tricuspid Regurgitation in Patients Undergoing Tricuspid Annuloplasty With Concomitant Left-Sided Valve Surgery: A Study on Rheumatic Valvular Heart Disease

Yan Chen et al. Front Cardiovasc Med. .

Abstract

Background: The presence of tricuspid regurgitation (TR) is very common in patients with concomitant left-sided valve disease. Recent studies have advocated an additional grading of massive TR that is beyond severe. The present study sought to characterize the spectrum of TR in patients undergoing tricuspid annuloplasty (TA) and to evaluate the prognostic value of TR severity for post-operative outcome following TA.

Methods: A total of 176 patients who underwent TA with combined left-sided valve surgery, secondary to rheumatic valvular heart disease, were prospectively evaluated. The severity of TR was quantified by effective regurgitant orifice area (EROA) using the proximal isovelocity surface area method. Patients were categorized as having non-massive TR (EROA < 0.6 cm2) or massive TR (EROA ≥ 0.6 cm2). Adverse outcome was defined as all-cause mortality or heart failure requiring hospital admission following TA.

Results: A total of 55 (31%) patients were considered to have massive TR. Patients with massive TR had a greater right ventricular dimension but a smaller left ventricular dimension compared with those with non-massive TR. After a median follow-up of 39 months, 35 adverse events occurred. Cox-regression analysis showed that both continuous EROA and dichotomized EROA (massive vs. non-massive TR) were independently associated with adverse events even after multivariable adjustment. Further, Harrell C index demonstrated that the addition of massive TR provided better discrimination ability of a prediction model to known prognosticators following TA.

Conclusions: Massive TR is common and up to 31% of study population had massive TR. Massive TR was associated with adverse outcome in patients undergoing TA. Classification of the severity of TR by quantitative measures and identification of massive TR in patients with concomitant left-sided valve disease are essential when considering the optimal timing of corrective surgery.

Keywords: adverse outcome; effective regurgitant orifice area (EROA); left-sided valve disease; rheumatic valvular heart disease; tricuspid annuloplasty; tricuspid regurgitation (TR).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Change in model Chi square with addition of massive tricuspid regurgitation (TR) to the other risk factors. The including parameters of each primary model was same as Table 3.
Figure 2
Figure 2
Kaplan-Meier analysis according to tricuspid regurgitation (TR) severity.
See this image and copyright information in PMC

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