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. 2024 Nov 4;66(5):ezae405.
doi: 10.1093/ejcts/ezae405.

Short-term outcome after isolated tricuspid valve surgery: prognostic role of right ventricular strain

Francesco Ancona  1 , Matteo Bellettini  2   3 , Giovanni Polizzi  1 , Gabriele Paci  1 , Davide Margonato  1 , Giacomo Ingallina  1 , Stefano Stella  1 , Giorgio Fiore  1 , Annamaria Tavernese  1 , Martina Belli  1 , Federico Biondi  1 , Alessandro Castiglioni  4   5 , Paolo Denti  4   6 , Nicola Buzzatti  4   6 , Gaetano Maria De Ferrari  2   3 , Ottavio Alfieri  4   5 , Elisabetta Lapenna  4 , Michele De Bonis  4   5 , Francesco Maisano  4   5   6 , Eustachio Agricola  1   5
Affiliations

Short-term outcome after isolated tricuspid valve surgery: prognostic role of right ventricular strain

Francesco Ancona et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: To assess the incremental prognostic value of right ventricular free wall longitudinal strain over conventional risk scores in predicting the peri-operative mortality in patients with severe tricuspid regurgitation (TR) undergoing isolated tricuspid valve (TV) surgery.

Methods: We retrospectively enrolled 110 consecutive patients with severe TR who underwent isolated TV surgery between November 2016 and July 2022 at San Raffaele Hospital, Milan, Italy. Exclusion criteria were previous TV surgery, urgent surgery, complex congenital heart disease, active endocarditis and inadequate acoustic window. Baseline clinical data were included, as well as laboratory tests and clinical risk score, as TRI-SCORE and MELD-XI. The clinical outcome was peri-operative mortality, defined as all-cause mortality within 30 days.

Results: The final cohort included 79 patients. The end-point occurred in 7 patients (9%), who died within 30 days after isolated TV surgery. Receiver operator characteristic curves analysis showed that, among parameters of right ventricular function, right ventricular free wall longitudinal strain was the best parameter to predict peri-operative mortality (AUC: 0.854, 95% CI 0.74-0.96, P = 0.005, sensitivity 68%, specificity 100%). At univariable analysis, left ventricular ejection fraction, diabetes mellitus, creatinine, estimated glomerular filtration rate, serum sodium, MELD-XI, TRI-SCORE, right ventricular areas, right ventricular global longitudinal strain, right ventricular free wall longitudinal strain, fractional area change and the ratio between right ventricular free wall longitudinal strain/pulmonary arterial systolic pressure were significantly associated with the end-point. The combination of TRI-SCORE and right ventricular Strain, evaluating right ventricular systolic function with speckle-tracking echocardiography, outperformed classic TRI-SCORE in outcome prediction (AUC 0.874 vs 0.787, P = 0.05).

Conclusions: Right ventricular free wall longitudinal strain has an incremental prognostic value over conventional parameters and significantly improves the ability of clinical scores to predict peri-operative mortality in patients undergoing isolated TV surgery.

Keywords: Isolated tricuspid valve surgery; Right ventricular free wall longitudinal strain; Tricuspid regurgitation.

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Figures

None
Graphical abstract
Figure 1:
Figure 1:
Prevalence of RV dysfunction according to different echocardiographic indices (upper panel) and reclassification of RV function according to RVFWLS (lower panel).
Figure 2:
Figure 2:
ROC curve analysis with echocardiographic parameters of RV function.
Figure 3:
Figure 3:
Kaplan–Meier curves according to RV dysfunction defined by RVFWLS.
Figure 4:
Figure 4:
ROC curve analysis including different TRI-SCORE models.
Figure 5:
Figure 5:
Incremental value of the RVFWLS and TAPSE over TRI-SCORE for predicting the primary end-point by global χ2 changes in sequential Cox analysis.
See this image and copyright information in PMC

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