Tethering Height Of Tricuspid Valve Predictor Of Recurrent Or Residual Functional Tricuspid Regurgitation In The Metaphase After Tricuspid Annuloplasty

Objective:To investigate the trans-thoracic echocardiographic predictors of recurrent or residual functional tricuspid regurgitation in the metaphase after tricuspid annuloplasty(TAP),especially the tethering height of tricuspid.Methods:A retrospective analysis of 344 rheumatic heart disease patients with tricuspid annuloplasty in the Fujian Medial University Union Hospital from January 2016 to December 2017.Of these,with echocardiography follow-up more than one year were involved.Finally,only 49 cases with 23.2 months mean follow-up years were selected.General clinical date(surgical approach,NYHA grading,atrial fibrillation,sex,etc.)were collected,and all the patients were assessed by trans-thoracic Doppler echocardiography(parameters include LVEF,RVFAC,PASP,TAD,tethering height and area of tricuspid valve,etc.)before operation and early stage(2 weeks)and medium stage(12 months-43 months)after TAP.Compared recurrence groups(TR>1year after surgery was moderate or more than moderate)with non-recurrence group(TR>1 year after surgery was mild or non)in echocardiographic parameters and preoperative general information to determine the predictor of recurrent or residual functional tricuspid regurgitation in the metaphase after TAP.Results:There were statistically significant differences within the groups of TR severity in different time points(preoperative,early and intermediate-term postoperative)(P<0.05).The TR severity of early postoperative was decreased than preoperative,but in the intermediate-term postoperative,the TR severity was increased over time.The influence of surgical approach(P=0.599),atrial fibrillation(P=0.694)and sex(P=0.496)to the TR severity had no significant differences.There were no significant differences in preoperative parameters(diameter of right atrial,left atrial,left ventricle,right ventricle,LVEF,RVFAC,PASP and TAD)and early postoperative parameters(diameter of right atrial,left atrial,right ventricle,LVEF、RVFAC)between the recurrence groups and non-recurrence group.The tethering height of TV(r=0.516,P<0.001),the tethering area of TV(r=0.368,P=0.009),the TR degree of preoperative(r=0.404,P=0.004),the TR degree(r=0.439,P=0.002)and the PASP(r=0.495,P<0.001)of early postoperative were positively correlated with the recurrence of TR>1 year after surgery.Variables which have clinical significance or simple factor analysis shows significance(TR degree of preoperative,tethering height,LVEF and PASP of early postoperative)were analyzed with binary logistics analysis,tethering height of TV(P<0.001)was found to be the only independent predictor of TR severity>1 year after TAP.The area under the tethering height of TV ROC curve was the largest with a cut-off point of 6.8mm with sensitivity of 66.7% and specificity of 97.3%.Conclusion:Tethering height of TV is an independent predictor of recurrent or residual TR,and the TR degree of preoperative and early postoperative,tethering area and PASP of early postoperative also has impact on TAP durability.These factors identify patients at risk for repair failure,such individuals require development of additional surgical plan to improve results of tricuspid valve repair and close surveillance after surgery.