Impact of pulmonary hypertension and right ventricular function on outcomes of isolated tricuspid valve surgery

Objective

To evaluate the impact of pulmonary hypertension and right ventricular dysfunction on outcomes of isolated tricuspid valve surgery.

Methods

From 2004 to 2022, 298 patients (age 71.0 ± years, 59.4% female) underwent isolated tricuspid valve surgery. Pulmonary hypertension was defined as right ventricular systolic pressure ≥50 mm Hg, and right ventricular dysfunction as right ventricular fractional area change <32% on preoperative transthoracic echocardiogram. Patients were stratified into 4 groups: group I: No pulmonary hypertension or right ventricular dysfunction (n = 199), group II: pulmonary hypertension without right ventricular dysfunction (n = 45), group III: right ventricular dysfunction without pulmonary hypertension (n = 43), and group IV: pulmonary hypertension and right ventricular dysfunction (n = 11). Uni- and multivariable analyses were performed to evaluate association of pulmonary hypertension and right ventricular function with outcomes.

Results

Tricuspid valve replacement was performed in 218 (73.2%) and repair in 80 (26.8%) patients. Operative mortality was 4.7%, similar for reoperations (5.2%) and primary procedures (4.5%) (P = .907). Median follow-up was 5.4 (interquartile range, 2.3-12.5) years, survival was 74.4%, 48.4%, 39.8%, and 67.3% in groups I-IV, respectively (P < .0001). Multivariable analysis identified pulmonary hypertension (hazard ratio, 2.9; 1.83-4.62, P < .001) and right ventricular dysfunction (hazard ratio, 2.83; 1.76-4.56, P < .001) as independent predictors of greater long-term all-cause mortality, in addition to older age (P < .001) and severe chronic lung disease (P < .001).

Conclusions

Among patients who underwent isolated tricuspid valve surgery, presence of pulmonary hypertension or right ventricular dysfunction at baseline is linked to greater long-term mortality.