Early Right Ventricular Reverse Remodeling Predicts Survival After Isolated Tricuspid Valve Surgery

BACKGROUND There are limited data on the impact of isolated tricuspid valve (TV) surgery on recovery of right ventricular (RV) function and RV reverse remodeling. METHODS Among 223 patients who had isolated TV procedures between 2001 and 2017, 60 (27%) underwent TV repair and 163 (73%) received TV replacement. Indication for surgery was functional tricuspid valve regurgitation in 64%, lead induced in 18%, and primary leaflet dysfunction in 18%. RV reverse remodeling was assessed by echocardiography at a median of 11.3 months (interquartile range [IQR] 5.9-13.5) post-dismissal . RESULTS Mean age was 67.3 +/- 13.7 years, and 57% were female. Overall 30-day mortality was 2.7%. After a median followup period of 9.5 years (IQR 3.6-12.9), adjusted Cox regression analysis revealed comparable survival for TV repair and replacement and identified older age, and presence of RV dysfunction (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.14-2.98; P = .01), as independent predictors of poor survival. Patients who exhibited RV reverse remodeling within 18 months postoperatively had significantly improved survival compared with those who did not (log-rank P = .005), and reverse remodeling was independently associated with improved survival (HR 0.42, 95% CI 0.24-0.74; P = .003). Lower preoperative right atrial pressure (odds ratio 0.83, 95% CI 0.73-0.94; P = .004) was predictive of early RV reverse remodeling. CONCLUSIONS Isolated TV surgery can be performed with acceptable outcomes (early mortality 2.7%), and overall survival is best in patients who receive the operation before developing RV systolic dysfunction. Adjusted survival was similar for patients undergoing TV repair or replacement. Early reverse remodeling of RV after surgery is associated with survival benefit. (Ann Thorac Surg 2021;112:1402-9) (c) 2021 by The Society of Thoracic Surgeons

Automated summary

Limited data are available on the impact of isolated tricuspid valve surgery on the recovery of right ventricular function and reverse remodeling. The study found that early mortality for isolated tricuspid valve surgery was 2.7%, and early reverse remodeling of the right ventricle postoperatively was associated with improved survival. Adjusted survival was similar for patients undergoing tricuspid valve repair or replacement.