Echocardiographic predictors of outcome after tricuspid valve surgery

Abstract

Mortality of isolated tricuspid surgery is high, close to 10%. We aimed to assess prognostic value of echocardiographic parameters among patients who underwent tricuspid valvular surgery. Preoperative echocardiograms were retrospectively reviewed in 75 patients (33 males, mean age 54 ± 17 years) hospitalized between 2007 and 2020. Parameters of right heart morphology including RV remodelling index: mid RV end diastolic (ED) diameter/RV ED length and RV function including RV peak systolic strain rate (SR) were measured. We calculated parameters combining load and function (load corrected SR (LcSR): maximal TR gradient (mTRG)/SR), morphology and function (remodelling corrected SR (RcSR): RVRI/SR) or load, morphology and function (load and remodelling corrected SR (LRcSR): mTRG/RVRI/SR) and compared them to 1 year and 5 years mortality Median of follow-up was 3 years. Mortality at 1 year was 17,3% and 22,7% at 5 years. There was no difference of RV morphologic parameters according to 1 year and 5 years mortality. Among classical RV function parameters, only S (11.4 ± 4.4 vs. 8.42 ± 1.7 at 1 yr P = 0.041; 11.4 ± 4.5 vs. 9.2 ± 2.5 at 5 yrs P = 0.020) and SR (1.6 ± 0.8 vs. 1 ± 0.3 at 1 yr P = 0.023; 1.6 ± 0.8 vs. 1.1 ± 0.3 at 5 yrs P = 0.025) were significantly different between alive and dead patients at 1 year and 5 years. All 3 combined parameters were significantly different according to 1 year (LcSR: 14.9 ± 6.2 vs. 20 ± 12.8 P = 0.001; RcSR: 40.8 ± 19.6 vs. 64.7 ± 32.8 P = 0.003; LRcSR: 7.9 ± 3.7 vs. 14.5 ± 7.3 P = 0.027) and 5 years mortality (LcSR: 14.8 ± 6.3 vs. 23.8 ± 11.8 P = 0.001; RcSR: 40.9 ± 19.9 vs. 60.2 ± 31.8 P = 0.012; LRcSR: 7.9 ± 3.8 vs. 13.5 ± 6.9 P = 0.001). By multivariate analysis, combined parameters were the only predictors of 1 year and 5 years mortality. Echography may help prognostic assessment of tricuspid valvular surgery. Combined parameters taking into account RV load, remodelling and function are the most important predictive factors.