Prognostic value of cardiac CT parameters in patients undergoing surgical correction for tricuspid regurgitation: a prospective study

Abstract

Background: Predictive value of perioperative cardiac computed tomography (CT) parameters, for long-term postoperative outcomes following tricuspid valve (TV) surgery is unclear. We investigated the prognostic value of perioperative cardiac CT-derived tricuspid annular and right ventricular (RV) parameters on long-term postoperative adverse outcomes after TV surgery.

Methods: We prospectively enrolled 66 patients who underwent corrective TV surgery for tricuspid regurgitation between June 2019 and January 2021 and had preoperative cardiac CT. Postoperative cardiac CT was performed 6 months after surgery. RV volume parameters were analyzed on the preoperative and postoperative cardiac CT images; the TV annulus diameter was measured from the preoperative CT. Postoperative adverse outcomes included death from any cause, unplanned postoperative admission, residual tricuspid regurgitation (≥ moderate), or RV systolic pressure >50 mmHg on postoperative echocardiography performed postoperative 6 months or later. Cox proportional hazard regression analyses were performed to identify significant imaging parameters associated with postoperative adverse outcomes. Restricted mean survival time was compared between groups at postoperative timepoints of 1 and 2 years.

Results: During postoperative follow-up period (mean 597.9±182.2 days), adverse outcomes occurred in 8 (12.1%) of 66 patients. Postoperative CT revealed RV volume changes of -21.6%±20.1% and -19.4%±23.3% for RV end-diastolic volume (RVEDV)/body surface area (BSA) and RV end-systolic volume (RVESV)/BSA, respectively. After adjusting for age, longer tricuspid annulus diameter (TAD)4ch/BSA and larger RVEDV/BSA and RV stroke volume (RVSV)/BSA on preoperative CT, and a greater extent of postoperative RVEDV/BSA reduction showed significant association with adverse outcomes. Among imaging parameters, the largest intergroup difference was observed in comparison by preoperative RVSV/BSA (cutoff 37.2 mL/m2) at postoperative 1-year timepoint (difference of 3.0 months, P<0.001) and RVEDV/BSA (cutoff 169.2 mL/m2) at postoperative 2-year timepoint (difference of 8.7 months, P<0.001).

Conclusions: Perioperative cardiac CT imaging-based TAD and RV volume can provide independent prognostic information for postoperative adverse outcomes in patients undergoing TV surgery.