TY - JOUR
T1 - Tricuspid Regurgitation and Pulmonary Haemodynamics After Pulmonary Endarterectomy
AU - Vanhoof, Bram
AU - Staal, Diederik P
AU - Quarck, Rozenn A
AU - Van Langenhoven, Leen
AU - Hofman, Frederik N
AU - Meyns, Bart
AU - Boerman, Sanne
AU - Godinas, Laurent
AU - Mager, Johannes J
AU - Belge, Catharina
AU - Post, Marco C
AU - De Meester, Pieter
AU - Delcroix, Marion
AU - Verbelen, Tom
N1 - Publisher Copyright:
© The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2025/9/1
Y1 - 2025/9/1
N2 - Objectives: To assess tricuspid regurgitation evolution after pulmonary endarterectomy and to identify predictive factors for residual postoperative tricuspid regurgitation. Methods: Perioperative and 6-month follow-up echocardiography and right heart catheterization data were retrospectively retrieved from all chronic thromboembolic pulmonary hypertension patients who underwent pulmonary endarterectomy between January 2009 and December 2023 in University Hospitals Leuven, Leuven and St. Antonius Hospital, Nieuwegein. Patients with vs without decreased tricuspid regurgitation and with vs without moderate/severe residual postoperative tricuspid regurgitation were compared. Results: Moderate/severe preoperative tricuspid regurgitation was present in 150/162 (93%) patients. It decreased with at least 1 degree 6 months postoperatively in 70/150 (47%) patients. In these patients, reductions in mean pulmonary artery pressure (−23 [−26; −21] vs −13 [−16; −11] mm Hg, P<.001), pulmonary vascular resistance (−6.73 [−7.61; −5.85] vs −3.28 [−4.05; −2.52] Wood units, P<.001), and N-terminal pro brain natriuretic peptide (ratio post-/preoperative measurement: 0.227 [0.168; 0.307] vs 0.968 [0.741; 1.265], P<.001) were larger than in patients without this decrease. Moderate/severe residual tricuspid regurgitation was seen in 26/162 (16%) patients. Postoperative mean pulmonary artery pressure (34 [30; 37] vs 24 [22; 25] mm Hg, P<.001) and pulmonary vascular resistance (5.54 [4.77; 6.31] vs 2.99 [2.65; 3.33] Wood units, P<.001) were higher in these patients vs those without moderate/severe residual tricuspid regurgitation. Arterial hypertension, older age, atrial fibrillation, shorter 6-min walking distance, and higher tricuspid regurgitation degree were potential preoperative risk factors for residual tricuspid regurgitation. Conclusions: In our study population, tricuspid regurgitation improvement after pulmonary endarterectomy was associated with improved pulmonary haemodynamics. Concomitant tricuspid valve annuloplasty might be considered in patients with atrial fibrillation and a dilated tricuspid valve annulus, but in the absence of risk factors for persistent pulmonary hypertension.
AB - Objectives: To assess tricuspid regurgitation evolution after pulmonary endarterectomy and to identify predictive factors for residual postoperative tricuspid regurgitation. Methods: Perioperative and 6-month follow-up echocardiography and right heart catheterization data were retrospectively retrieved from all chronic thromboembolic pulmonary hypertension patients who underwent pulmonary endarterectomy between January 2009 and December 2023 in University Hospitals Leuven, Leuven and St. Antonius Hospital, Nieuwegein. Patients with vs without decreased tricuspid regurgitation and with vs without moderate/severe residual postoperative tricuspid regurgitation were compared. Results: Moderate/severe preoperative tricuspid regurgitation was present in 150/162 (93%) patients. It decreased with at least 1 degree 6 months postoperatively in 70/150 (47%) patients. In these patients, reductions in mean pulmonary artery pressure (−23 [−26; −21] vs −13 [−16; −11] mm Hg, P<.001), pulmonary vascular resistance (−6.73 [−7.61; −5.85] vs −3.28 [−4.05; −2.52] Wood units, P<.001), and N-terminal pro brain natriuretic peptide (ratio post-/preoperative measurement: 0.227 [0.168; 0.307] vs 0.968 [0.741; 1.265], P<.001) were larger than in patients without this decrease. Moderate/severe residual tricuspid regurgitation was seen in 26/162 (16%) patients. Postoperative mean pulmonary artery pressure (34 [30; 37] vs 24 [22; 25] mm Hg, P<.001) and pulmonary vascular resistance (5.54 [4.77; 6.31] vs 2.99 [2.65; 3.33] Wood units, P<.001) were higher in these patients vs those without moderate/severe residual tricuspid regurgitation. Arterial hypertension, older age, atrial fibrillation, shorter 6-min walking distance, and higher tricuspid regurgitation degree were potential preoperative risk factors for residual tricuspid regurgitation. Conclusions: In our study population, tricuspid regurgitation improvement after pulmonary endarterectomy was associated with improved pulmonary haemodynamics. Concomitant tricuspid valve annuloplasty might be considered in patients with atrial fibrillation and a dilated tricuspid valve annulus, but in the absence of risk factors for persistent pulmonary hypertension.
KW - Aged
KW - Echocardiography
KW - Endarterectomy/adverse effects
KW - Female
KW - Hemodynamics/physiology
KW - Humans
KW - Hypertension, Pulmonary/surgery
KW - Male
KW - Middle Aged
KW - Postoperative Complications/epidemiology
KW - Pulmonary Artery/surgery
KW - Pulmonary Embolism/surgery
KW - Retrospective Studies
KW - Tricuspid Valve Insufficiency/physiopathology
UR - https://www.scopus.com/pages/publications/105017414604
U2 - 10.1093/ejcts/ezaf298
DO - 10.1093/ejcts/ezaf298
M3 - Article
C2 - 41014608
SN - 1010-7940
VL - 67
JO - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
IS - 9
M1 - ezaf298
ER -