Predictors of late improvement of significant remnant tricuspid regurgitation detected early after tricuspid annuloplasty.

BACKGROUND

In some patients with severe tricuspid regurgitation (TR) who undergo tricuspid annuloplasty (TAP), significant remnant TR is detected early after TAP but diminishes after long-term follow-up. We sought to investigate the outcome of significant residual TR early after TAP and the predictors for late improvement of TR.

METHODS

A total of 58 consecutive patients presenting with moderate to severe TR early (5.7 ± 2.0 days) after TAP and before discharge were enrolled in this study. Echocardiography was repeated for 32.3 ± 28.6 months after TAP, and improvements in TR were defined as mild or less TR. Clinical data and echocardiographic studies were retrospectively analyzed.

RESULTS

Twenty-nine (50%) patients showed late improvement in TR during follow-up. Multivariate Cox regression analysis revealed that tricuspid valve (TV) tenting height measured early after TAP (P = 0.020) and execution of the Maze procedure with TAP (P = 0.049) were independent predictors for late improvement of significant early remnant TR. The rates of late TR improvement were higher in patients with an early postoperative TV tenting height ≥ 9.1 mm (P = 0.026) and in patients who underwent a Maze procedure (P = 0.033) than in other groups of patients.

CONCLUSIONS

Half of patients with significant remnant TR early after TAP show late improvement in TR. Evaluation of a combined Maze procedure and TV tenting height early after TAP will help identify patients for whom repeated TV surgery may be deferred.