Tricuspid annuloplasty significantly reduced RA diameter by 4 mm (p=0.007) and RV basal diameter by 4.5 mm (p<0.001), with stable RV EF but decreased longitudinal function.
Does tricuspid annuloplasty improve right heart geometry and function in patients with moderate or severe functional tricuspid regurgitation?
Tricuspid annuloplasty leads to favorable right heart remodeling with reduced right atrial and ventricular dimensions, though longitudinal right ventricular function decreases as an adaptive response.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Tricuspid annuloplasty (TAP) is a widely used surgical intervention for functional tricuspid regurgitation (FTR). While its primary aim is to reduce annular dilation and improve valve coaptation, its broader effects on right heart geometry and function remain insufficiently explored. This study investigates how TAP influences right ventricular (RV) and right atrial (RA) dimensions and function beyond the tricuspid annulus. AIM This study aims to evaluate the impact of TAP on right heart parameters, including RV geometry, RA size, and functional indices, using advanced 3D echocardiography. Methods This study adopted a prospective observational cohort design to investigate the impact of TAP. The emphasis was on patients with moderate or severe FTR related to left heart valvular disease, primarily characterized by severe mitral regurgitation. Participants with ischemic heart disease were excluded from the analysis. The cohort comprised 66 individuals who underwent preoperative assessments utilizing both 2D and 3D echocardiography. These assessments involved quantifying RV and RA geometry, as well as functional RV parameters. TR severity was assessed following the recent ESC guidelines. Based on TAP outcomes, patients were divided into two groups: the effective TA group (50 patients) and the recurrent TR group (16 patients). Effective TA was defined as exhibiting mild-moderate TR one-year post-surgery and was included in this analysis, while the recurrent TR group displayed significant moderate-severe TR and were excluded from further investigation. Statistical analyses were conducted using SPSS, with paired comparisons assessing changes in right heart parameters following TAP. Results Following TAP, significant reductions in RA and RV dimensions were observed. RA diameter decreased from 49 (IQR 9.3) mm to 45 (6.5) mm (p=0.007), RA area from 26.9 (10.6) cm² to 21.7 (6.3) cm² (p0.001), and RA volume from 92 (64) ml to 68 (31) ml (p0.001). Similarly, RV basal diameter reduced from 44.5 (7) mm to 40 (4.5) mm (p0.001), and middle diameter from 35 (7.3) mm to 31 (7.5) mm (p0.001). The sphericity index decreased from 0.55 (0.13) to 0.47 (0.11) (p0.001), indicating a more elliptical RV shape. While end-diastolic volume and end-systolic volume decreased significantly (p=0.010 and p=0.030, respectively), RV ejection fraction remained unchanged (p=0.582). However, fractional area change improved from 32 (8) % to 34 (10) % (p=0.011), suggesting a slight enhancement in RV systolic function. TAPSE decreased from 18 (9) mm to 16 (5) mm (p=0.003), and RV S' from 10.4 (5) cm/s to 9.0 (2) cm/s (p0.001), indicating a decline in longitudinal RV contraction. Conclusion TAP significantly reduces RA and RV dimensions, indicating favorable remodeling effects on right heart structures. Although the RV EF remained unchanged, longitudinal RV function decreased, indicating an adaptive response to the intervention.
Krivickienė et al. (Sat,) reported a other. Tricuspid annuloplasty significantly reduced RA diameter by 4 mm (p=0.007) and RV basal diameter by 4.5 mm (p<0.001), with stable RV EF but decreased longitudinal function.