Association between right ventricular linear dimensions and early tricuspid regurgitation recurrence after surgical repair for functional tricuspid regurgitation

OBJECTIVES: Functional tricuspid regurgitation (fTR) commonly occurs in patients with right ventricular (RV) dysfunction, and surgical repair typically results in positive long-term outcomes. However, the association between preoperative RV echocardiography linear dimensions and postoperative TR recurrence remains unclear. This study aims to determine if preoperative RV linear dimensions can predict early TR recurrence. METHODS: A retrospective study was conducted on patients who underwent surgical annular reduction for fTR between 2018 and 2022. Preoperative and postoperative RV dimensions, including RVD1 (basal diameter), RVD2 (mid-cavity diameter), RVD3 (longitudinal diameter), RVOT-D (RV outflow-tract diameter), and RVOT-FS (Fractional Shortening), were measured via echocardiography. Early TR recurrence was defined as moderate to severe TR within six months postoperatively. RESULTS: Among 210 patients, 77 (36.67 %) experienced TR recurrence within six months (median = 95 days, IQR:23-125). The TR group had significantly larger RVD1, RVD2, RVD3, and RVOT-D compared to the non-TR group (RVD1, 4.0 cm versus 3.6 cm, P < 0.001; RVD2, 2.65 cm versus 2.4 cm, P = 0.007; RVD3, 5.85 cm versus 5.3 cm, P = 0.001; RVOT-D, 3.1 cm versus 2.8 cm, P = 0.004), while RVOT-FS was significantly lower (22.22 % versus 34.37 %, P < 0.001). Logistic-regression indicated that only RVOT-FS significantly impacted TR recurrence (odds ratio = 0.86, P < 0.001). Receiver operating characteristic analysis identified RVOT-FS≤29.17 % was the best predictor of early TR recurrence (Youden index = 0.59; sensitivity = 84.42 %; specificity = 74.44 %; Area-under-curve = 0.826, P < 0.001). CONCLUSIONS: Larger preoperative RV dimensions and reduced RVOT-FS are associated with early TR recurrence after annular reduction. Traditional annular reduction may be insufficient in patients with RVOT-FS ≤ 29.17 %.