Prevalence,Predictors and Clinical Outcome of Residual Pulmonary Hypertension Following Tricuspid Annuloplasty

Background: tricuspid annuloplasty is increasingly performed during left heart valve surgery,but the long-term clinical outcome postoperatively is not satisfactory. the aim of this study was to determine whether residual pulmonary hypertension (pht) contributes to the adverse outcome.methods and results: one-hundred thirty-seven patients (age 61±11 years; men,30%) who underwent tricuspid annuloplasty during left-side valve surgery were enrolled. the mean pulmonary artery systolic pressure before surgery was 49±13 mm hg and 32±15 mm hg following surgery. patients were divided into 3 groups according to postoperative pulmonary artery systolic pressure: no residual pht (n=78,57%),mild residual pht (n=43,31%),or significant residual pht (n=16,12%). a preoperative larger right ventricular (rv) geometry and tricuspid valve tethering area were associated with mild or significant residual pht. a total of 24 adverse events (20 heart failures and 4 cardiovascular deaths) occurred during a median follow-up of 25 months. kaplan-meier survival curve demonstrated that patients with significant residual pht had the highest percentage of adverse events followed by those with mild residual pht. patients with no residual pht had a very low risk of adverse events. multivariable cox regression analysis revealed that both mild (hazard ratio=4.94; 95% ci =1.34-18.16; p=0.02) and significant residual pht (hazard ratio=8.67; 95% ci =2.43-30.98; p<0.01) were independent factors associated with adverse events.conclusions: the present study demonstrated that 43% of patients who underwent tricuspid annuloplasty had residual pht. the presence of mild or significant residual pht was associated with adverse events in these patients. © 2016 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.