Is the pulmonary pressure directly correlated with the operative risk in patients with isolated tricuspid valve surgery?

BACKGROUND

Severe pulmonary hypertension is a relative contraindication for isolated tricuspid valve (TV) surgery. However, some patients may still benefit from TV surgery. We hypothesized that pulmonary pressure alone is an inadequate predictor of outcomes post-TV surgery, and that aorto-pulmonary pressure quotient (AoP/PAP) is a better predictor.

METHODS

From 2005 to 2019, a total of 122 patients (mean age: 68.5±10.5 years; 43.3% male) with isolated TV regurgitation and preoperative right heart catheterization referred to our institution for isolated TV surgery were included. Patients with concomitant procedures were excluded from this analysis. All data were retrospectively analyzed. Follow-up was 97% complete.

RESULTS

The mean follow-up time was 4.3±3.6 years. The mean preoperative New York Heart Association (NYHA) class was 2.9±0.7, left ventricular ejection fraction was 52.3±11.3%, creatinine level was 124.8±102.6μmol/l, mean pulmonary artery pressure was 25.5±9.4mmHg, mean MELD-XI score 13.5±4.2, and mean AoP/PAP was 4.1±1.9 mmHg. Thirty-day mortality was 10.9%, and 5-years survival was 56.6±4.9%. Cox regression analysis revealed age (P=0.001; HR: 1.058; CI 95%: 1.023-1.094), the mean arterial pressure (P=0.002; HR: 0.969; CI 95%: 0.950-0.988) and systolic pulmonary artery pressure (P=0.035; HR: 1.054; CI 95%: 1.004-1.107), as well as mean AoP/PAP>4 (P=0.001; HR: 6.678; CI 95%: 2.197-20.294) as predictors for long-term mortality.

CONCLUSIONS

Regardless of the degree of pulmonary hypertension, a mean AoP/PaP quotient ≤4 impacts the postoperative survival of patients undergoing isolated TV surgery. However, further research is still required to verify this finding.