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Echocardiographic Determinants of Tricuspid Regurgitation Persistence After Surgical Annuloplasty
Session:
Sessão de Posters 30 - Intervenções valvulares cirúrgicas e transcateter para além da válvula aórtica
Speaker:
Ricardo Carvalheiro
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.3 Valvular Heart Disease – Diagnostic Methods
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Ricardo Carvalheiro; Pedro Félix; Miguel Figueiredo; Vera Vaz Ferreira; Rui Cerejo; Manuel Magalhães; António Tomás; Hagen Kahlbau; Ana Isabel Galrinho; Rui Rodrigues; Rui Cruz Ferreira; Pedro Coelho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Determinants of residual or recurrent tricuspid regurgitation (TR) after tricuspid valve surgery remain a matter of debate. This study evaluated echocardiographic predictors of significant postoperative TR at 1-year follow-up.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We retrospectively analyzed 203 patients undergoing tricuspid annuloplasty in a single center between 2018 and 2024. Baseline clinical and echocardiographic variables were evaluated. Significant TR at 1 year follow-up was defined as grade ≥2+. Univariable and multivariable logistic regressions were performed to examine associations between echocardiographic variables and TR severity at follow-up. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Baseline characteristics are summarized in Table 1. TR grading at 1 year was available in 155 patients, of whom 35 (22.6%) had significant TR. On univariable analysis, preoperative TR grade (OR 2.66 [1.48–4.76], p=0.002), TAPSE (OR 0.82 [0.73–0.93], p=0.002), TAPSE/sPAP (OR 0.03 [0.00–0.39], p=0.008), right atrial volume indexed (RAVi) (OR 1.03 [1.01–1.05], p=0.008), and RV free-wall strain (OR 0.91 [0.83–0.99], p=0.041) were significant predictors. RV basal diameter (p=0.078) and tricuspid annular diameter (p=0.051) showed borderline associations, while FAC was not associated with TR recurrence. Mitral regurgitation grade was significant but became non-associated after accounting for mitral surgery.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Variables entered into the multivariable model were preoperative TR grade, TAPSE, and RAVi. In the adjusted analysis, TAPSE remained the only independent predictor of significant postoperative TR (OR 0.80 [0.69–0.93], p=0.004), while preoperative TR grade showed only a borderline association (OR 1.97 [0.99–3.88], p=0.053) and RAVi was not independently significant (OR 1.015 [0.994–1.033], p=0.114). Substituting TAPSE with TAPSE/sPAP worsened model performance, confirming that TAPSE alone offered the strongest and most stable predictive value in this cohort.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Notably, while preoperative sPAP was not associated with postoperative TR (p = 0.069), sPAP at discharge was significantly associated (OR 1.06 [1.03–1.10], p=0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Reduced preoperative RV longitudinal function, as reflected by TAPSE, was the strongest independent predictor of significant residual or recurrent TR one year after tricuspid annuloplasty, while TR grade, RAVi, TAPSE/sPAP, and RV strain showed relevant univariable associations. The lack of association between baseline sPAP and outcomes, contrasted with the strong predictive value of postoperative sPAP, suggests that preoperative pulmonary pressures may be confounded by TR severity and left-sided disease, and that sPAP after surgery better reflects the true pulmonary vascular load that drives TR persistence. These findings highlight the pivotal role of RV function and pulmonary hemodynamics in determining durability after tricuspid surgery.</span></span></p>
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