OC27 FAILURE OF TRICUSPID ANNULOPLASTY FOR FUNCTIONAL TRICUSPID REGURGITATION. THE ROLE OF PREOPERATIVE AND LATE RIGHT VENTRICULAR REMODELING

Abstract

Background and Aims: To identify the role of preoperative and late right ventricular (RV) remodeling in tricuspid annuloplasty (TAP) late failure. Methods: From May 2009 to December 2015, 423 patients undergoing TAP received transthoracic echocardiographic evaluation both at discharge and after a median of 3 years. Recurrence TR were defined as TR higher than mild at follow up. Cox analysis was used as multivariable model for late failure. Results: Recurrent TR was recorded in 85 (20%) cases, Five-year freedom from TR recurrence was 74.0 ± 3.0%. Risk factors were residual TR, atrial fibrillation at follow-up, mild or moderate TR with TV apparatus /RV remodeling, severe TR, RV dilatation either preoperative or at follow-up. The entire cohort was divided into four groups: group A with neither preoperative nor at follow-up RV dilatation (149); group B with positive RV remodeling (134); group C with negative RV remodeling (n = 28)); and group D with persistent RV dilatation (n = 112). TR recurrence was recorded significantly higher in groups C and D (Figure). Risk factors for late RV dilatation were preoperative mild or moderate TR with TV apparatus or RV remodeling, preoperativesevere TR, preoperative left and right ventricular dysfunction. Conclusions: RV remodeling is one of the determinant after TAP and can be predicted on the basis of several preoperative echocardiographic parameters, including left and right ventricular function and TR severity. In these cases, the surgical approach should not be limited to TAP, but surgeons should consider alternative techniques or prosthesis implantation.