Tricuspid Regurgitation and Pulmonary Haemodynamics After Pulmonary Endarterectomy

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.