Prognostic implications of staging right heart failure in patients with significant tricuspid regurgitation undergoing tricuspid valve surgery

Abstract Introduction Mortality of tricuspid valve (TV) surgery for severe secondary regurgitation (TR) remains relatively high. Current guidelines advise in patients with symptomatic TR as a concomitant procedure to left-sided surgery. Right ventricular (RV) dysfunction is an important prognostic marker and may appear late the natural history TR. How staging algorithm right heart failure (RHF) impact on TV outcomes has not been evaluated. Purpose To evaluate RHF survival significant undergoing Methods Patients diagnosed (moderate severe) who subsequently underwent surgery, were staged into 4 groups progressive disease according diagnosis RV presence RHF: stage 1, at risk RHF; 2, without clinical symptoms 3, RHF, 4, refractory (Figure 1). The study endpoint was all-cause mortality. Results A total 279 (mean age 64±12 years, 49% male), included analysis, which 20 (7%) 14 (5%) 141 (51%) 3 104 (37%) 4. majority (266 patients, 95%) annuloplasty. Most had or coronary artery bypass grafting (254 91%). In per-group significantly larger left (LV) dimensions, lower LV ejection fraction more diastolic than other stages. During median follow-up 65 [15 - 106] months after 145 deaths (52%) occurred. cumulative rates 88%, 77% 60% 1 month, year 5 respectively. Kaplan-Meier curves overall are shown Figure 2. Survival years worse advanced stages 71% (stage 2), 66% 3) 4); log-rank chi-square: 11.302; p=0.004. independently associated mortality following adjustment age, gender, fraction, kidney function, annulus diameter, mitral time delay from until (p=0.021). Conclusion benefit earlier referral surgical intervention, before presenting onset RHF. Funding Acknowledgement Type funding sources: None. 1. Stages failureFigure