Prevalence, predictors and clinical outcome of residual pulmonary hypertension following tricuspid annuloplasty

Abstract

BACKGROUND: Tricuspid annuloplasty (TA) is increasingly performed during left heart valve surgery but the postoperative clinical outcome is poor. PURPOSE: The aim of this study was to determine whether residual pulmonary hypertension (PHT) contributes to the adverse outcome. METHODS: 137 patients (age, 61±11 years; men, 30%) who underwent TA during left-side valve surgery were enrolled. The mean pulmonary artery systolic pressure (PASP) before surgery was 49±13mmHg and 32±15mmHg following surgery. Patients were divided into three groups according to postoperative PASP: no residual PHT (n=78, 57%), mild residual PHT (n=43, 31%), or significant residual PHT (n=16, 12%). RESULTS: A preoperative larger RV geometry and TV tethering area were associated with mild or significant residual PHT. A total of 24 adverse events (20 heart failure and 4 cardiovascular death) occurred during a median follow-up of 25 months. Kaplan-Meier survival curve demonstrated that patients with significant residual PHT had the highest percentage of adverse events followed by those with mild residual PHT. Patients with no residual PHT had a very low risk of adverse events. Multivariable Cox regression analysis revealed that both mild (hazard ratio=4.94; 95% confidence interval=1.34–18.16; P=0.02) and significant residual PHT (hazard ratio=8.67; 95% confidence interval=2.43–30.98; P<0.01) were independent factors associated with adverse events. CONCLUSIONS: The present study demonstrated that 43% of patients who underwent TA had residual PHT. The presence of mild or significant residual PHT was associated with adverse events in these patients.