Degree of right ventricular dysfunction dictates outcomes after tricuspid valve repair concomitant with left-side valve surgery

Abstract

Objectives The effect of different degrees of right ventricular (RV) dysfunction on long-term outcomes after tricuspid valve repair is the subject of ongoing research. We sought to evaluate the effect of preoperative RV dysfunction on mortality and recurrence of tricuspid regurgitation (TR) after tricuspid valve repair for secondary TR concomitant with left-side valve surgery. Methods This is a retrospective study, including 548 patients who underwent repair of secondary TR (2009-2017) at a single institution. Patients were grouped according to preoperative right ventricular (RV) systolic function into three groups; normal RV function (group 1, n = 451), mild RV dysfunction (group 2, n = 60) and moderate/severe RV dysfunction (group 3, n = 37). Study endpoints were mortality and recurrence of TR. Results Group 3 was associated with the highest hospital mortality (10.2%, p = .06). Predictors of moderate or higher grade TR were NYHA class (HR 2.1, p = 0.03); preoperative TR grade (HR 1.9, p < 0.01), mild RV dysfunction (HR 2.4, p < 0.01), isolated RV dilatation (HR 2.0, p < 0.01), and flexible TV repair prostheses (HR 2.4, p = 0.01). Predictors of mortality were renal impairment (HR 3.0, p < 0.01), ejection fraction (HR 0.97, p = 0.02), pulmonary artery systolic pressure (HR 1.02, p = 0.02), preoperative TR grade (HR 1.7, p < 0.01), and moderate/severe RV dysfunction (HR 3.1, p = 0.01). Conclusion Compared to normal and mild degree of RV dysfunction, moderate and severe RV dysfunction were independent predictors of poor long-term survival. Isolated RV dilatation increased the recurrence of TR. RV dysfunction and dilatation could be indications of tricuspid valve repair.