Determinants Of Mid-Term Outcomes Of Tricuspid Annuloplasty For Functional Tricuspid Regurgitation

Objectives The purpose of this retrospective study was to summarize the mid-term clinical and echocardiographic outcomes of tricuspid valvuloplasty(TVP), to compare the curative effect of different tricuspid annuloplasty techniques,and to identify the risk factors of postoperative residual tricuspid regurgitation(PRTR).Methods Between August 2005 and February 2007,222 patients underwent tricuspid annuloplasty for functional tricuspid regurgitation in the Department of Cardiac Surgery of Zhongshan Hospital affiliated to Fudan University.Male 89 cases(40.1%),female 133 cases(59.9%),aged 50.0±12.0 yrs,using 2 main techniques: non-ring procedure in 136 patients(61.3%),and ring procedure in 86 patients(38.7%). Postoperative follow-ups were performed on echocardiography and NYHA.Mid-term outcomes of TVP was summarized.The determinants of PRTR was identified,and the curative effect of different tricuspid annuloplasty techniques was compared,by means of clinical and echocardiographic follow-ups.Results There were 2 perioperative death(0.99%),no diffrerence between two groups(P =.588).Mean follow-up time was 24.4±10.9 months(15 days to 42 months),lost of follow-up were in 20 cases(9.0%).Mean preoperative TR grade was 2.5±1.1 +,mean postoperative TR grade was 0.7±0.8 +(P＜.01);Mean preoperative NYHA was 3.1±0.5,mean postoperative NYHA was 1.4±0.5(P＜.01). PRTR occurred in 27 cases(13.5%).Tricuspid reoperation rate was 0%,survival rate was 97.5%.Severity of preoperative TR was higher in ring group(P＜.01),and severity of postoperative TR was similar(P =.269).In patients with TR 3+ to 4+ preoperatively,the severity of postoperative TR in ring group was lower than non-ring group(P =.044).The change rate of TR was higher in ring group(P =.021). In condition of preoperative atrial fibrillation(P =.001),LA＞60mm(P =.011), sPAP＞65mmHg(P =.036) or TR 3+ to 4+(P =.047),ring group shared higher change rate of TR than non-ring group.In multivariate analysis,rheumatic etiology(P =.026,OR = 9.9),postoperative right atrium size(P =.003,OR = 2.9),less postoperative LVEF(P =.025,OR = 4.4),postoperative sPAP＞50mmHg(P =.029, OR = 4.2),and higher postoperative sPAP(P =.020,OR = 4.9) were independent risk factors of PRTR.Conclusions TVP is an effective procedure treating FTR.The echocardiographic mid-term outcome of ring group was better than non-ring group, especially when preoperative 3+ to 4+ TR,or in condition of preoperative atrial fibrillation,huge LA or pulmonary artery hypertension.Rheumatic etiology, postoperative right atrium size,less postoperative LVEF,postoperative pulmonary artery hypertension and higher postoperative sPAP showed independent association with PRTR.