Right Ventricular Reverse Remodeling After Tricuspid Valve Surgery for Significant Tricuspid Regurgitation

Xavier Galloo; Maria Chiara Meucci; Jan Stassen; Marlieke F Dietz; Edgard A Prihadi; Pieter van der Bijl; Nina Ajmone Marsan; Jerry Braun; Jeroen J Bax; Victoria Delgado

doi:10.1016/j.shj.2022.100101

Right Ventricular Reverse Remodeling After Tricuspid Valve Surgery for Significant Tricuspid Regurgitation

Struct Heart. 2022 Nov 4;7(1):100101. doi: 10.1016/j.shj.2022.100101. eCollection 2023 Jan.

Authors

Xavier Galloo^{1

2}, Maria Chiara Meucci^{1

3}, Jan Stassen^{1

4}, Marlieke F Dietz¹, Edgard A Prihadi^{1

5}, Pieter van der Bijl¹, Nina Ajmone Marsan¹, Jerry Braun⁶, Jeroen J Bax^{1

7}, Victoria Delgado¹

Affiliations

¹ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
² Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
³ Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.
⁴ Department of Cardiology, Jessa Hospital, Hasselt, Belgium.
⁵ Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.
⁶ Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
⁷ Heart Center, University of Turku and Turku University Hospital, Turku, Finland.

Abstract

Background: Changes in right ventricular (RV) dimensions and function after tricuspid valve (TV) surgery and their association with long-term outcomes remain largely unexplored. The current study evaluated RV reverse remodeling, based on changes in RV dimensions and function, after TV surgery for significant (moderate or severe) tricuspid regurgitation (TR) and their association with outcome.

Methods: A total of 121 patients (mean age 63 ± 12 years, 47% males) with significant TR treated with TV surgery were included in this analysis. The population was stratified by tertiles of percentage reduction of RV end-systolic area (RVESA) and absolute change of RV fractional area change (RVFAC). Five-year mortality rates were compared across the tertiles of RV remodeling and independent associates of mortality were investigated.

Results: Tertile 3 consisted of patients presenting with a reduction in RVESA ≥17.2% and an improvement in RVFAC ≥2.3% after TV surgery. Cumulative survival rates were significantly better in patients within tertile 3 of RVESA reduction: 90% vs. 49% for tertile 1 and 69% for tertile 2 (log-rank p = 0.002) and within tertile 3 of RVFAC improvement: 87% vs. 57% for tertile 1 and 65% for tertile 2 (log-rank p = 0.02). Tertiles 3 of RVESA reduction and RVFAC improvement were both independently associated with better survival after TV surgery compared to tertiles 1 (hazard ratio: 0.221 [95% CI: 0.074-0.658] and 0.327 [95% CI: 0.118-0.907], respectively).

Conclusions: The extent of RV reverse remodeling, based on reduction in RVESA and improvement in RVFAC, was associated with better survival at 5-year follow-up of TV surgery for significant TR.

Keywords: Prognosis; Right ventricular remodeling; Tricuspid regurgitation; Tricuspid valve surgery.