TRICUSPID ANNULOPLASTY CONCOMITANT WITH LEFT-SIDED CARDIAC SURGERY INDUCES RIGHT VENTRICULAR REMODELING

Abstract

Background: Tricuspid valve annuloplasty (TVP) has been advocated concomitantly with complex left-sided cardiac surgery in case of severe functional tricuspid regurgitation (TR) or isolated tricuspid annular dilatation (TAD, diameter > 4,0cm or 2,1cm/m2) in the absence of TR. Data on postoperative right ventricular (RV) remodeling are lacking in these patients. Methods: Pre- and postoperative echocardiographical data from 45 consecutive TVP procedures performed during left-sided cardiac surgery (mainly mitral valve) in a tertiary surgical center were retrospectively analyzed and compared to a contemporary control group of 33 procedures without concomitant TVP. Changes in RV function and geometry were analyzed by measuring RV size, fractional area change and RV end-diastolic sphericity index (RVSI=long-axis length/short-axis width) at baseline and follow-up. Results: At 4,5 months follow-up, a significant beneficial increase in RVSI was observed in TVP patients (figure 1), whereas the opposite was seen in the control group. Indexed RV end-diastolic area increased significantly only in the control group, likely due to ongoing adverse remodeling. Postoperative RV fractional area change declined non-significantly in both groups. Conclusions: Adding TVP to left-sided cardiac surgery in patients with severe TR or isolated TAD leads to favorable changes in RV geometry and prevents ongoing postoperative RV dilation. Adding TVP to complex left-sided surgery has no adverse effect on RV function.