Key result
PTE alone cuts moderate-to-severe functional tricuspid regurgitation by an absolute ~45 percentage points.
Why the study?
Whether concomitant tricuspid annuloplasty should be performed in patients with CTEPH and tricuspid regurgitation undergoing pulmonary thromboendarterectomy remains controversial.
Does pulmonary thromboendarterectomy without concomitant tricuspid annuloplasty alleviate functional tricuspid regurgitation in patients with chronic thromboembolic pulmonary hypertension and high pulmonary vascular resistance?
Cohort (n=45)
Two independent investigators did the analysis and the investigators were blinded to whether the images were from before or after surgery.
No
Does pulmonary thromboendarterectomy without concomitant tricuspid annuloplasty alleviate functional tricuspid regurgitation in patients with chronic thromboembolic pulmonary hypertension and high pulmonary vascular resistance?
Functional tricuspid regurgitation in patients with advanced CTEPH and high pulmonary vascular resistance improves substantially within one month after pulmonary thromboendarterectomy alone, suggesting routine concomitant tricuspid annuloplasty may not be necessary.
Supports deferring routine tricuspid annuloplasty in CTEPH; hypothesis-generating pending randomized confirmation.
Background: For patients with chronic thromboembolic pulmonary hypertension (CTEPH) and tricuspid regurgitation (TR) undergoing pulmonary thromboendarterectomy (PTE), whether concomitant tricuspid annuloplasty should be carried out is still controversial. Methods: The study population consisted of 45 consecutive patients with CTEPH who were scheduled to undergo PTE. All PTE surgeries were conducted with a median sternotomy and deep hypothermia circulatory arrest (DHCA). We collected and analyzed the demographics, surgical details, echocardiographic parameters, and right heart catheterization (RHC) results of these patients. Results: Moderate to severe TR was documented in 48.9% (22/45) of the patients pre-operatively and 4.4% (2/45) of the patients post-operatively. In patients with grade 4 TR, severity decreased to grade 2 in 8 and to grade 1 in 1. In patients with grade 3 TR, severity decreased to grade 2 in 9, to grade 1 in 3, and 1 remained unchanged. In patients with grade 2 TR, severity decreased to grade 1 in 8, and 15 remained unchanged. The post-operative TR velocity was decreased significantly (431.9±53.4 vs. 196.5±154.0, P<0.001). Pulmonary artery systolic pressure was 84±17 mmHg pre-operatively and decreased to 38±14 mmHg post-operatively (P<0.001). The pre and post-operative pulmonary diastolic pressure was 29±9 and 17±7 mmHg, respectively (P<0.001). The pre and post-operative mean pulmonary pressure was 48±10 and 24±9 mmHg, respectively (P<0.001). The pulmonary vascular resistance (PVR) (1,025.4±465.0 vs. 476.6±181.2 dynes·sec·cm−5, P<0.001) and pulmonary artery wedge pressure (PAWP) (9±4 vs. 5±2 mmHg, P<0.001) decreased significantly after operation. The cardiac index (CI) increased significantly (1.9±0.5 vs. 2.3±0.4, P=0.003) after operation. Conclusions: In conclusion, functional TR could be alleviated after PTE even in patients with high PVR. However, the long-term results need to be further investigated.
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Zhen et al. (2020) conducted a cohort in Chronic thromboembolic pulmonary hypertension (CTEPH) with functional tricuspid regurgitation (TR) (n=45). Pulmonary thromboendarterectomy (PTE) without concomitant tricuspid annuloplasty vs. Pre-operative baseline was evaluated on Moderate to severe tricuspid regurgitation (grade 3 or 4) (p=<0.01). Pulmonary thromboendarterectomy without tricuspid annuloplasty reduced moderate-to-severe functional tricuspid regurgitation from 48.9% pre-operatively to 4.4% post-operatively (P<0.01).
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