Key result
Tricuspid annuloplasty is linked to an absolute ~3.7-point drop in RVFWLS despite preserved RVFAC.
Why the study?
Preoperative-to-late postoperative changes in right ventricular indices required assessment in patients undergoing cardiac surgery including tricuspid annuloplasty, predominantly with concomitant mitral valve surgery.
Does cardiac surgery including tricuspid annuloplasty alter right ventricular echocardiographic indices (RVFAC, RVFWLS, TAPSE, and S') from preoperative baseline to late postoperative follow-up?
Cohort (n=63)
No
Does cardiac surgery including tricuspid annuloplasty alter right ventricular echocardiographic indices (RVFAC, RVFWLS, TAPSE, and S') from preoperative baseline to late postoperative follow-up?
Preserved right ventricular fractional area change at late follow-up after tricuspid annuloplasty frequently masks reduced right ventricular free-wall longitudinal strain, indicating that RVFAC alone is insufficient to assess late postoperative RV function.
Answers are grounded in this paper and cite their sources.
TA with left-sided surgery was associated with late RV recovery; leaves open whether it improves outcomes versus surgery alone.
PURPOSE: This single-center retrospective study assessed preoperative-to-late postoperative changes in right ventricular (RV) indices in patients undergoing cardiac surgery including tricuspid annuloplasty, predominantly with concomitant mitral valve surgery. METHODS: This retrospective cohort study analyzed 63 patients with paired preoperative and late postoperative echocardiography after tricuspid annuloplasty. RV fractional area change (RVFAC), RV free-wall longitudinal strain (RVFWLS), tricuspid annular plane systolic excursion (TAPSE), and tissue Doppler tricuspid annular peak systolic velocity (S') were compared over time. RVFAC >35% and absolute RVFWLS >20% were classified as preserved. RESULTS: Late echocardiography was performed at a median of 47 months. No statistically significant within-patient change in RVFAC was detected (37.9% to 37.4%; Hodges-Lehmann estimate, -1.0 percentage points; 95% confidence interval [CI], -3.0 to +0.7; p = 0.231), whereas RVFWLS decreased from 19.2% to 15.7% (median within-patient change, -3.1 percentage points; Hodges-Lehmann estimate, -3.7 percentage points; 95% CI, -5.3 to -2.3; p < 0.001); TAPSE and S' were also lower at late follow-up (both p < 0.001). At follow-up, 30 of 37 patients with preserved RVFAC had reduced RVFWLS. CONCLUSION: In patients undergoing tricuspid annuloplasty, predominantly with concomitant mitral valve surgery, preserved RVFAC at late follow-up does not necessarily indicate preserved RV free-wall longitudinal deformation. RVFAC alone may be insufficient to characterize RV function at late postoperative follow-up in this setting.
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Nakai et al. (2026) conducted a cohort in Cardiac surgery including tricuspid annuloplasty, predominantly with concomitant mitral valve surgery (n=63). Tricuspid annuloplasty (late postoperative state) vs. Preoperative baseline was evaluated on Within-patient change in right ventricular free-wall longitudinal strain (RVFWLS) and fractional area change (RVFAC) (Hodges-Lehmann estimate -3.7 percentage points, 95% CI -5.3 to -2.3, p=<0.001).
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