title: Prevalence, Predictors and Clinical Outcome of Residual Pulmonary Hypertension Following Tricuspid Annuloplasty.
abstract: Tricuspid annuloplasty is increasingly performed during left heart valve surgery, but the long-term clinical outcome postoperatively is not satisfactory. The aim of this study was to determine whether residual pulmonary hypertension (PHT) contributes to the adverse outcome.
  
  
  
  One-hundred thirty-seven patients (age 61±11 years; men, 30%) who underwent tricuspid annuloplasty during left-side valve surgery were enrolled. The mean pulmonary artery systolic pressure before surgery was 49±13 mm Hg and 32±15 mm Hg following surgery. Patients were divided into 3 groups according to postoperative pulmonary artery systolic pressure: no residual PHT (n=78, 57%), mild residual PHT (n=43, 31%), or significant residual PHT (n=16, 12%). A preoperative larger right ventricular (RV) geometry and tricuspid valve tethering area were associated with mild or significant residual PHT. A total of 24 adverse events (20 heart failures and 4 cardiovascular deaths) occurred during a median follow-up of 25 months. Kaplan-Meier survival curve demonstrated that patients with significant residual PHT had the highest percentage of adverse events followed by those with mild residual PHT. Patients with no residual PHT had a very low risk of adverse events. Multivariable Cox regression analysis revealed that both mild (hazard ratio=4.94; 95% CI =1.34-18.16; P=0.02) and significant residual PHT (hazard ratio=8.67; 95% CI =2.43-30.98; P<0.01) were independent factors associated with adverse events.
  
  
  
  The present study demonstrated that 43% of patients who underwent tricuspid annuloplasty had residual PHT. The presence of mild or significant residual PHT was associated with adverse events in these patients.
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China.
authors.forename: Ju-Hua
authors.initials: JH
authors.lastname: Liu
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chan
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China.
authors.forename: Ko-Yung
authors.initials: KY
authors.lastname: Sit
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China.
authors.forename: Chun-Ka
authors.initials: CK
authors.lastname: Wong
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China.
authors.forename: Kar-Lai
authors.initials: KL
authors.lastname: Ho
authors.affiliation: School of Public Health, The University of Hong Kong, China.
authors.forename: Lai-Ming
authors.initials: LM
authors.lastname: Ho
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhen
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China.
authors.forename: Yui-Ming
authors.initials: YM
authors.lastname: Lam
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China.
authors.forename: Chu-Pak
authors.initials: CP
authors.lastname: Lau
authors.affiliation: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, China.
authors.forename: Wing-Kok
authors.initials: WK
authors.lastname: Au
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China.
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
authors.affiliation: Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, China Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, China Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Hong Kong, China khkyiu@hku.hk.
authors.forename: Kai-Hang
authors.initials: KH
authors.lastname: Yiu
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D058385:Cardiac Valve Annuloplasty; D002318:Cardiovascular Diseases / Q000401:mortality*; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D012214:Rheumatic Heart Disease / Q000453:epidemiology / Q000601:surgery*; D013318:Stroke Volume; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*
keywords: pulmonary hypertension; tricuspid annuloplasty; valvular surgery