Preoperative fractional shortening of the tricuspid annulus <25% was associated with a 57.1% incidence of late negative results compared to 0% in patients with >25% (P=0.0001).
Cohort (n=50)
Does preoperative fractional shortening of the tricuspid annulus predict late negative results after tricuspid valve repair guided by annulus diameter in patients with rheumatic mitral disease?
Preoperative fractional shortening of the tricuspid annulus is a strong predictor of late functional outcomes in patients undergoing tricuspid annuloplasty for secondary tricuspid regurgitation.
Absolute Event Rate: 57.1% vs 0%
p-value: p=0.0001
Methods. A prospective analysis was performed on 50 patients (pts) with rheumatic mitral disease and associate secondary tricuspid insufficiency who underwent mitral valve replacement from January 1995 to December 1998. Surgical indication to tricuspid annuloplasty was considered in patients with echocardiographic tricuspid annulus diameter >21 mm/m2, regardless semiquantitative evaluation of tricuspid insufficiency. De Vega annuloplasty was performed in 33 out of 50 patients. Results. Hospital mortality was 2.0% (CL 0.3–3.6). The follow up of the discharged patients ranged from 3 to 48 months (mean 25±15.9). Three late deaths occurred (6.1% CL 2.8–9.2). Forty-two patients out of the 46 followed up (91.3% CL 84.9–93.8) were in I or II NYHA class. In eight patients (16.3% of discharged patients) the obtained result has been considered as ‘negative late results’: persisting moderate (three cases) or moderate-severe (five cases) TrI, together with congestive heart failure requiring a furosemide intake of >25 mg/day. No patients had severe TrI at follow up. The statistics analysis demonstrated the ‘preoperative fraction shortening of the tricuspid annulus’ (P=0.038) as factor predictive of late negative result. The incidence of late negative result was 57.1% among patients with fractional shortening lower than 25% and 0% among those patients with fractional shortening greater than 25% (P=0.0001). Conclusions. The choice to treat the tricuspid insufficiency according to indexed tricuspid annulus dimension (>21 mm/m2) has been effective in terms of clinical efficacy and of late functional result. Fractional shortening of the tricuspid annulus, expression of right ventricular cardiomyopathy in patients with poorest prognosis, affects the postoperative evolution of tricuspid insufficiency.
Tiziano Colombo (Wed,) conducted a cohort in Rheumatic mitral disease and secondary tricuspid insufficiency (n=50). Preoperative fractional shortening of the tricuspid annulus <25% vs. Fractional shortening >25% was evaluated on Late negative result (persisting moderate or moderate-severe tricuspid insufficiency with congestive heart failure) (p=0.0001). Preoperative fractional shortening of the tricuspid annulus <25% was associated with a 57.1% incidence of late negative results compared to 0% in patients with >25% (P=0.0001).