• Yan Chen, Ying-Xian Liu, Yu-Juan Yu, Mei-Zhen Wu, Yui-Ming Lam, Ko-Yung Sit, Daniel Tai-Leung Chan, Cally Ka-Lai Ho, Lai-Ming Ho, Li-Gang Fang, Shu-Yang Zhang, Chu-Pak Lau, Wing-Kuk Au, Hung-Fat Tse, and Kai-Hang Yiu.
• Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China; Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College and Medical Imaging Key Laboratory, Nan Chong, China.
• J Am Soc Echocardiogr. 2019 Dec 1; 32 (12): 1516-1525.

BackgroundThe advent of three-dimensional echocardiography (3DE) enables detailed evaluation of the tricuspid valve (TV) apparatus; nonetheless, the clinical value of preoperative 3DE is unknown in patients undergoing tricuspid annuloplasty (TA). The aim of this study was to evaluate the prognostic value of TV geometric parameters and leaflet coaptation status evaluated by 3DE in patients undergoing TA.MethodsA total of 122 patients who underwent TA during left-sided heart valve surgery were prospectively evaluated. Detailed 3DE was performed before surgery. Adverse outcome was defined as the occurrence of heart failure requiring hospital admission or all-cause mortality following TA.ResultsA total of 33 adverse events (17 heart failures and 16 deaths) occurred during a median follow-up of 36 months. Tethering volume (hazard ratio = 1.32; 95% CI = 1.05-1.66; P = .01) and ratio of total leaflet length to closure length (hazard ratio = 1.07; 95% CI = 1.03-1.12; P < .01) were associated with adverse events after adjustment for age, sex, and tricuspid regurgitation vena contracta width. Receiver-operator characteristic curve analysis revealed that tethering volume (area under curve = 0.73) and ratio of total leaflet length to closure length (area under curve = 0.75) were most associated with adverse events at 1-year follow-up. The presence of either a large tethering volume or a low ratio of total leaflet length to closure length was predictive of an adverse outcome 1 year following TA.ConclusionsOur study suggests that 3DE-derived TV tethering volume and ratio of total leaflet length to closure length are important preoperative measures associated with adverse events in patients undergoing TA.Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

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