Echocardiographic predictors of outcome after tricuspid valve surgery - 03/06/21
Résumé |
Introduction |
Mortality of isolated tricuspid surgery is high, close to 10%. We aimed to assess prognostic value of echocardiographic parameters among patients who underwent tricuspid valvular surgery.
Method |
Preoperative echocardiograms were retrospectively reviewed in 75 patients (33 males, mean age 54±17 years) hospitalized between 2007 and 2020. Parameters of right heart morphology including RV remodelling index: mid RV end diastolic (ED) diameter/RV ED length and RV function including RV peak systolic strain rate (SR) were measured. We calculated parameters combining load and function (load corrected SR (LcSR): maximal TR gradient (mTRG)/SR), morphology and function (remodelling corrected SR (RcSR): RVRI/SR) or load, morphology and function (load and remodelling corrected SR (LRcSR): mTRG/RVRI/SR) and compared them to 1 year and 5 years mortality
Results |
Median of follow-up was 3 years. Mortality at 1 year was 17,3% and 22,7% at 5 years. There was no difference of RV morphologic parameters according to 1 year and 5 years mortality. Among classical RV function parameters, only S (11.4±4.4 vs. 8.42±1.7 at 1 yr P=0.041; 11.4±4.5 vs. 9.2±2.5 at 5 yrs P=0.020) and SR (1.6±0.8 vs. 1±0.3 at 1 yr P=0.023; 1.6±0.8 vs. 1.1±0.3 at 5 yrs P=0.025) were significantly different between alive and dead patients at 1 year and 5 years. All 3 combined parameters were significantly different according to 1 year (LcSR: 14.9±6.2 vs. 20±12.8 P=0.001; RcSR: 40.8±19.6 vs. 64.7±32.8 P=0.003; LRcSR: 7.9±3.7 vs. 14.5±7.3 P=0.027) and 5 years mortality (LcSR: 14.8±6.3 vs. 23.8±11.8 P=0.001; RcSR: 40.9±19.9 vs. 60.2±31.8 P=0.012; LRcSR: 7.9±3.8 vs. 13.5±6.9 P=0.001). By multivariate analysis, combined parameters were the only predictors of 1 year and 5 years mortality.
Conclusion |
Echography may help prognostic assessment of tricuspid valvular surgery. Combined parameters taking into account RV load, remodelling and function are the most important predictive factors.
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Vol 13 - N° 3
P. 251 - juin 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.