Tricuspid regurgitation in patients undergoing pericardiectomy for constrictive pericarditis

Tricuspid regurgitation (TR) may complicate pericardial constriction; however, its incidence, impact on outcome, and appropriate management are not defined.

Between January 1993 and March 2006, 481 adult patients underwent pericardiectomy at Mayo Clinic, Rochester, Minnesota. Excluding those with pericardiectomy for reasons other than constriction, previous tricuspid valve surgery, malignant infiltration, and those undergoing other concomitant cardiac operations, 261 patients remained for evaluation of echocardiographic TR before and after surgery as well as early and late survival.

Tricuspid regurgitation was present in 71% of patients (185 of 261); in 20% (54 of 261), TR was graded moderate or severe. Operative mortality was higher (7 of 54, 13%) among those with moderate/severe TR (7 of 54, 13%, versus 9 of 207, 4.3%; p = 0.019), and by multivariate analysis, moderate/severe TR was an independent predictor of late mortality (hazard ratio: 2.9, 95% confidence level: 1.5 to 5.6; p < 0.001). After excluding patients with prior radiation, moderate/severe TR was no longer a predictor of operative risk, but remained associated with poorer late survival (5-year survival 47% with versus 87% without). Among those with moderate/severe TR, operative mortality was similar if repair was or was not undertaken (2 of 20, 10%, versus 5 of 34, 15%; p = not significant), and late survival was not impacted. Without intervention, however, TR improved in only 29% (8 of 28).

Tricuspid regurgitation frequently complicates constrictive pericarditis, and when moderate or severe, is associated with increased mortality. Although valve repair has little impact on late survival, TR seldom improves with pericardiectomy alone, and may be considered to reduce symptoms, as it can be undertaken without increasing operative risk.