Predictors and Clinical Impact of Tricuspid Regurgitation after Pericardiectomy for Constrictive Pericarditis

Postoperative progression of tricuspid regurgitation (TR) is an adverse consequence after pericardiectomy in patients with constrictive pericarditis (CP). We aimed to identify predictors, as well as the clinical significance, of TR development following pericardiectomy in CP patients.

A total of 132 CP patients with mild or less TR before pericardiectomy, performed between March 1991 and March 2023, were enrolled. Patients were divided into two groups based on TR severity on pre-discharge echocardiography. Patients who maintained mild or less TR were assigned into the no-TR group, whereas those who showed significant (moderate or greater) TR were assigned into the TR group. The primary endpoint was all-cause death.

Among the 132 patients, 110 patients (83.3%) were classified into the no-TR group and 22 patients (16.7%) into the TR group. The median follow-up period was 4.65 years. A low body surface area, presence of diabetes mellitus, large mitral valve (MV) annulus diameter, and left atrial volume index (LAVI) were predictors of significant TR after pericardiectomy. The optimal cutoff values for MV annulus diameter and LAVI were 30.51 mm and 31.65 mL/m2, respectively. All-cause mortality was significantly higher in the TR group than in the no-TR group (hazard ratio 2.26; 95% confidence interval 1.09-4.70; log-rank p = 0.018).

An enlarged left atrium is a risk factor for postoperative significant TR resulting in poor survival after pericardiectomy in CP patients. These results may help to identify patients who may benefit from combined tricuspid valve surgery.