Right ventricular dysfunction, but not significant tricuspid regurgitation, was independently associated with mortality late after left heart valve procedures (22% overall mortality).
Cohort (n=539)
Does significant tricuspid regurgitation or right ventricular dysfunction independently impact survival late after left heart valve procedures?
Right ventricular dysfunction, rather than the presence of significant tricuspid regurgitation itself, is the independent driver of late mortality after left heart valve procedures.
p-value: p=<0.001
BACKGROUND: Significant tricuspid regurgitation (TR) late after left heart valve procedure is frequent and associated with increased morbidity. Surgical correction carries a significant mortality risk, whereas the impact of TR on survival in these patients is unclear. OBJECTIVES: This study sought to assess the impact of significant TR late after left heart valve procedure. METHODS: A total of 539 consecutive patients with previous left heart valve procedure (time interval from valve procedure to enrollment 50 ± 30 months) were prospectively followed for 53 ± 15 months. RESULTS: Significant TR (defined as moderate or greater severity by echocardiography) was present in 91 (17%) patients (65% female). Patients with TR presented with more symptoms (New York Heart Association functional class ≥II 55% vs. 31%), lower glomerular filtration rates (61 ± 19 ml/min vs. 68 ± 18 ml/min), and a higher likelihood of atrial fibrillation (41% vs. 20%), all statistically significant. Right ventricular (RV) systolic function was worse in patients with significant TR (RV fractional area change 43 ± 11% vs. 47 ± 9%, p < 0.001). A total of 117 (22%) patients died during follow-up. By Kaplan-Meier analysis, overall survival was significantly worse in patients with significant TR (log-rank p < 0.001). However, by multivariable Cox analysis, only RV fractional area change, age, left atrial size, diabetes, and previous coronary artery bypass graft procedure were significantly associated with mortality, but not tricuspid regurgitation. CONCLUSIONS: RV dysfunction, but not significant TR, is independently associated with survival late after left heart valve procedure.
Kammerlander et al. (Mon,) conducted a cohort in Previous left heart valve procedure (n=539). Significant tricuspid regurgitation and right ventricular dysfunction vs. Absence of significant TR or RV dysfunction was evaluated on Mortality (p=<0.001). Right ventricular dysfunction, but not significant tricuspid regurgitation, was independently associated with mortality late after left heart valve procedures (22% overall mortality).
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