Key result
Massive TR is linked to higher mortality and heart failure after tricuspid annuloplasty.
Why the study?
Recent studies have advocated an additional grading of massive TR beyond severe, but the spectrum of TR and its prognostic value for post-operative outcomes following TA remained to be characterized.
Does the presence of massive tricuspid regurgitation predict adverse outcomes in patients undergoing tricuspid annuloplasty with concomitant left-sided valve surgery for rheumatic heart disease?
Cohort (n=176)
Does the presence of massive tricuspid regurgitation predict adverse outcomes in patients undergoing tricuspid annuloplasty with concomitant left-sided valve surgery for rheumatic heart disease?
Massive tricuspid regurgitation (EROA ≥ 0.6 cm²) is common and independently predicts adverse outcomes in patients undergoing tricuspid annuloplasty with concomitant left-sided valve surgery for rheumatic heart disease.
May support risk stratification after annuloplasty; leaves open whether EROA-targeted intervention improves outcomes.
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 cm 2 ) or massive TR (EROA ≥ 0.6 cm 2 ). 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.
No takes yet. Share an insight, caveat, or question.
Chen et al. (2022) conducted a cohort in Rheumatic valvular heart disease (n=176). Massive tricuspid regurgitation (EROA ≥ 0.6 cm2) vs. Non-massive tricuspid regurgitation (EROA < 0.6 cm2) was evaluated on All-cause mortality or heart failure requiring hospital admission. Massive tricuspid regurgitation (EROA ≥ 0.6 cm2) was present in 31% of patients undergoing tricuspid annuloplasty and was independently associated with adverse outcomes over a median 39 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: