Imaging and haemodynamic parameters associated with clinical outcomes following isolated tricuspid valve surgery

Abstract

IntroductionIsolated tricuspid valve surgery (TVS) may be associated with high morbidity and mortality. The aim of this study was to investigate the association of preoperative imaging and haemodynamic data derived from echocardiography (ECHO), cardiac magnetic resonance (CMR) and right heart catheterisation (RHC) with postoperative outcomes following TVS.MethodsIn a retrospective cohort study, patients who underwent isolated TVS at our institution between 2012 and 2020 were screened and followed up to 1 year. We only included those who had all three tests before surgery: ECHO, CMR and RHC. Patients with congenital heart disease, infective endocarditis and those who underwent concomitant valve or pericardial surgery were excluded. The primary outcome was a composite of mortality and congestive heart failure at 1 year. Time-to-event analyses at 1 year and Cox proportional hazards regression analyses were performed.ResultsA total of 60 patients were included (mean age of 60±14 years, 63% women), of whom 67% underwent TV repair. The primary outcome occurred in 16 patients (27%) with a 1-year mortality of 7%. It was associated with ECHO-derived right ventricular (RV) free wall strain and RHC-derived RV systolic and diastolic as well as mean pulmonary pressures. On multivariable Cox regression analysis, only RV systolic and diastolic pressures were significantly associated with the primary outcome at 1 year (HRs=5.9 and 3.4, respectively, p<0.05).ConclusionBaseline invasive haemodynamic assessment could have a strong association with clinical outcomes and help risk-stratify patients undergoing isolated TVS.

The right ventricle systolic force ratio could predict the severity of the tricuspid regurgitation‐RIVIERA ratio

“…This could make sense given that chronic right ventricle (RV) volume overload brought on by severe self‐perpetuating TR may cause the RV to enlarge and remodel over time, which could then result in gradual, irreversible RV myocardial injury and right heart failure 6 . Retrospective registries show that patients with severe TR have an elevated mortality risk compared to those who do not have the condition, with revealed 1 year overall mortality rates of up to nearly 50% vs. 8%, respectively 4,7–10 . TR severity has been evaluated with reasonable specificity in comparison to reference standards using a number of qualitative and semiquantitative parameter values.…”

“…6 Retrospective registries show that patients with severe TR have an elevated mortality risk compared to those who do not have the condition, with revealed 1 year overall mortality rates of up to nearly 50% vs. 8%, respectively. 4,[7][8][9][10] TR severity has been evaluated with reasonable specificity in comparison to reference standards using a number of qualitative and semiquantitative parameter values.…”