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Development of tricuspid regurgitation after left-side heart surgery
Session:
SESSÃO DE POSTERS 31 - VALVULOPATIA MITRAL E TRICÚSPIDE - DIAGNÓSTICO E INTERVENÇÃO VALVULAR
Speaker:
Mónica Dias
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Mónica Dias; Rodrigo Silva; Carolina Ferreira; Sofia Fernandes; Inês Conde; Carla Ferreira; Filipe Vilela; Nuno Salomé; Carla Marques Pires
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:NewsGotT">INTRODUCTION: The current practices for diagnosing, managing, and treating right-sided heart valve disease vary greatly. There is a lack of robust information regarding the incidence and predictors of tricuspid regurgitation (TR) development following left-sided heart surgery.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:NewsGotT">AIM: To evaluate the incidence and predictors of TR development after left-sided surgery in patients without an indication for tricuspid valve (TV) intervention at the time of surgery; to assess the prognostic impact of TR development in these patients.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:NewsGotT">METHODS: We conducted a retrospective observational study including patients from inpatient care in our center who underwent heart surgery between 2011 and 2019. "Group T" consisted of patients who underwent TV intervention, while "group no-T" included those who did not. Unadjusted (Kaplan-Meier) and adjusted (Cox regression) survival analyses were performed to evaluate the occurrence of a composite endpoint (mortality and/or heart failure (HF) hospitalization).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:NewsGotT">RESULTS: The study included 320 patients (60,3% male, median age 74 [IQR 16] years). 73 patients underwent TV annuloplasty (group T), while 247 did not. Of these, 245 had no indication for TV intervention (group no-T). The median follow-up period was 3.92 years [IQR 4.3]. During this time, 48.6% died from any cause and 23.4% required hospitalization due to a deterioration of their heart failure status, with no differences between the groups. A worsening of preoperative TR was observed in 12.4% of patients, with a higher prevalence in the no-T group (14.5% vs. 5.9%, p<0.001).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:NewsGotT">Patients with worsening TR were more likely to be female, older at the time of surgery, have a higher prevalence of COPD, and experience a higher incidence of atrial fibrillation (AF). In multivariate analysis, COPD was the only significant predictor of worsening TR (p=0.047; OR=3.43). Patients with worsening TR had significantly higher rates of heart failure hospitalization (50% vs. 19%, p<0.001), mortality (52% vs. 29%, p=0.039), and composite endpoint (72% vs. 49%, p=0.004). On multivariate analysis, COPD (p=0.025; OR=8.137), left ventricular ejection fraction deterioration (p=0.029; OR=13.943), and worsening TR (p=0.041; OR=4.538) were identified as predictors of the composite endpoint. However, Kaplan-Meier curves showed no significant difference in time to event between groups (p=0.091).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:NewsGotT">DISCUSSION: TR may progress in a significant proportion of patients following left-side cardiac surgery. As TR progression is associated with a worse late prognosis, a more liberal approach to addressing TR during left-sided surgery, or at least closer clinical and echocardiographic monitoring postoperatively, may be justified in patients with risk factors.</span></span></span></p>
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