Does Prosthetic Replacement Impact Right Ventricular Reverse Remodeling In Patients Undergoing Isolated Tricuspid Valve Surgery?
Sri Harsha Patlolla, Hartzell V. Schaff, Juan A. Crestanello, Joseph A. Dearani, Richard C. Daly, Robert L. Frye, Rick A. Nishimura.
Mayo Clinic, Rochester, MN, USA.
OBJECTIVE: Tricuspid valve repair (TVrep) is associated with sustained improvement in right ventricular (RV) function, but TV replacement (TVR) may lead to progressive RV dysfunction induced by the rigid prosthesis.To better understand the impact of isolated TVrep and TVR on RV reverse remodeling, we analyzed RV function and dilatation longitudinally following the correction of isolated TR. METHODS: Patients who underwent isolated TV procedures (July 2003-November, 2017) with echocardiographic evaluation preoperatively, prior to dismissal, between 3-18 months, and between 18-36 months postoperatively formed the study cohort (n=63). Proportions of patients with moderate/severe RV dysfunction and dilatation were compared between TVrep and TVR groups. Between-group and within-group comparisons were done using Fisher's exact test and Cochran’s Q test respectively.RESULTS: Mean age of the study cohort was 65.7±14.8 years, and 47.6% were female. All patients had moderately-severe or greater degree of TR and less than moderate aortic/mitral valve dysfunction. Etiology of TV disease was functional (59%), pacemaker-induced (22%), and primary leaflet abnormalities (19%). TVrep was performed in 30% and TVR in 70% of patients. Preoperatively, the proportion of patients with moderate/severe RV dysfunction and dilatation was comparable in both TVrep and TVR groups. Early postoperatively, TVR group had a higher proportion of patients with moderate/severe residual RV dilatation (65% vs 41%) and moderate/severe RV systolic dysfunction (52% vs 32%) compared to TVrep group. By 36 months RV systolic function had recovered in approximately 70% of patients in both groups. Similarly, RV size recovered to normal or mild dilatation by 36 months after operation in 72% of patients having TVrep and 81% of TVR (both p<0.01).
CONCLUSIONS: Surgical correction of isolated severe TR initiates RV reverse remodeling with resulting improvement in RV function and RV size. Changes appeared to be of similar magnitude by 36 months in patients having TV repair or replacement.
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