Prognostic value of preoperative right ventricular geometry and tricuspid valve tethering area in patients undergoing tricuspid annuloplasty.
BACKGROUND
Patients who undergo tricuspid annuloplasty during left-side heart valve surgery have a poor postoperative clinical outcome. However, preoperative right ventricular (RV) echocardiography parameters that predict adverse events in these patients are poorly understood.


RESULTS
We studied 74 patients (age, 58±10 years; men, 27%) with significant tricuspid regurgitation who consequently underwent tricuspid annuloplasty during left-side heart valve surgery. A total of 26 adverse events (22 heart failures and 4 cardiovascular deaths) occurred during a median follow-up of 26 months. RV midcavity diameter (hazard ratio=2.44; 95% confidence interval=1.48-4.02; P<0.01), RV longitudinal dimension (hazard ratio=1.64; 95% confidence interval=1.10-2.45; P=0.02), and tricuspid valve tethering area (hazard ratio=3.25; 95% confidence interval=1.71-6.19; P<0.01) were independently associated with adverse events after adjustment for age and New York Heart Association class III/IV. Receiver-operator characteristic curve analysis demonstrated that RV midcavity diameter (area under the curve=0.74; P<0.01) and tricuspid valve tethering area (area under the curve=0.70; P=0.04) were most associated with adverse events at the 1-year follow-up. The presence of either a large RV midcavity diameter or tricuspid valve tethering area was predictive of adverse outcome at 1 year after tricuspid annuloplasty.


CONCLUSIONS
The present study demonstrates that RV geometry dimensions, namely RV midcavity diameter and tricuspid valve tethering area, are important preoperative measures associated with adverse events in patients undergoing tricuspid annuloplasty.
Division of Cardiology, Department of Medicine (K.-H.Y., A.W., L.P., M.-F.C., H.-Y.L., Y.-M.L., Y.C., C.-W.S., C.-P.L., H.-F.T.) and Department of Surgery (K.-Y.S., D.C., W.-K.A.), University of Hong Kong, Queen Mary Hospital, Hong Kong; Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong (K.-H.Y., C.W.-S, H.-F.T.); and Department of Medicine, Affiliated Hospital of North Sichuan Medical College, Sichuan, China (L.P.).
Kai-Hang
KH
Yiu
Arthur
A
Wong
Lijun
L
Pu
Man-Fung
MF
Chiang
Ko-Yung
KY
Sit
Daniel
D
Chan
Hou-Yee
HY
Lee
Yui-Ming
YM
Lam
Yan
Y
Chen
Chung-Wah
CW
Siu
Chu-Pak
CP
Lau
Wing-Kok
WK
Au
Hung-Fat
HF
Tse
D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D015588:Observer Variation; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*
echocardiography; surgery; valves, surgical