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Incremental prognostic value of early postoperative right ventricular systolic function in patients undergoing surgery for isolated severe tricuspid regurgitation
  1. Kyungil Park1,
  2. Hyung-Kwan Kim2,
  3. Yong-Jin Kim2,
  4. Goo-Yeong Cho2,
  5. Kyung-Hwan Kim3,
  6. Ki-Bong Kim3,
  7. Dae-Won Sohn2,
  8. Hyuk Ahn3,
  9. Byung-Hee Oh2,
  10. Young-Bae Park2
  1. 1Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
  2. 2Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
  3. 3Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
  1. Correspondence to Hyung-Kwan Kim, Division of Cardiology, Department of Internal Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea; cardiman73{at}gmail.com

Abstract

Background Preoperative right ventricular end-systolic area (RV-ESA) and haemoglobin level have been suggested to be independent predictors of long-term prognosis in patients undergoing corrective surgery for isolated severe tricuspid regurgitation (TR).

Aims To investigate whether early postoperative echocardiography provides useful prognostic information in addition to preoperative clinical and echocardiographic variables.

Methods 69 consecutive patients undergoing corrective surgery for isolated severe TR (60 women, mean 57.6±8.9 years) were studied. Comprehensive preoperative echocardiography was performed in all patients, with early postoperative echocardiography in all patients except one. During follow-up (median 40 months, range 6–86 months), clinical events were investigated, defined as operative mortality, cardiovascular death, repeated open heart surgery and readmission due to cardiovascular problems.

Results 28 patients (41%) were categorised as New York Heart Association class II, 36 (52%) as III and 5 (7%) as IV. 63 patients (91.3%) had undergone prior left-sided valve surgery. Seven (10.1%) patients died before discharge. Of the remaining 62 patients, three died during follow-up, and eight required readmission due to cardiovascular problems. On multivariate analyses using clinical and preoperative variables, RV-ESA (p=0.006) and haemoglobin level (p<0.001) were independent predictors of event-free survival. When early postoperative echocardiography variables were included, preoperative haemoglobin and early postoperative RV-FAC were predictors of long-term event-free survival. On receiver-operating characteristic curve analysis, early postoperative RV-FAC≥31% predicted event-free survival with a sensitivity of 90% and a specificity of 83% (p<0.001). The addition of early postoperative echocardiographic RV-FAC markedly improved the prognostic utility of the model containing preoperative haemoglobin level and echocardiographic RV-ESA (p<0.001).

Conclusion Early postoperative RV-FAC, measured by echocardiography, provided valuable information additional to preoperative RV-ESA and hemoglobin level that was useful for predicting long-term clinical events following corrective TR surgery.

  • Tricuspid valve insufficiency
  • surgery
  • treatment outcome
  • echocardiography
  • surgery-valve
  • tricuspid valve disease

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Footnotes

  • Funding This study was partly supported by grants from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (A090064) and Handok Pharmaceutical 2010 Research Fund.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Seoul National University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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