Fate of Tricuspid Valve Regurgitation after Pulmonary Endarterectomy in Chronic Thromboembolic Pulmonary Hypertension

Purpose Pulmonary thromboendarterectomy (PTE) is a standard procedure for the treatment of chronic thromboembolic pulmonary hypertension. PTE decreases pulmonary hypertension, though its effect on secondary tricuspid regurgitation (TR) is unclear. Methods We retrospectively reviewed patients who received PTE from June 2009 to July 2019 at our center. Echocardiographic assessments of tricuspid regurgitation peak valve gradient (TRPG), right ventricular (RV) systolic dysfunction, and degree of TR were tracked longitudinally after PTE (1 month, 6 months, 12 months, 24 months, 36 months). Mixed effects longitudinal analysis was used to determine changes in echocardiographic parameters and risk factors for residual TR. The effect of moderate-severe TR on survival was assessed by cox proportional hazards analysis. Results In the 235 patients that underwent PTE, the mean pulmonary artery pressure at time of surgery was 43 +/- 14 mmHg. Preoperatively, 54 patients (23%) had trace TR, 59 (25%) mild, 42 (18%) mild-moderate, 50 (21%) moderate, 19 (8%) moderate-severe, and 9 (4%) severe. TR decreased at all time points postoperatively (p Conclusion TR improved significantly three years after PTE with the exception of patients with residual pulmonary hypertension, preoperative RV dysfunction, and female sex. Preoperative but not postoperative TR may be a marker of poor prognosis after PTE.