Work

Tricuspid valve leaflet multiplicity and Doppler-derived right-heart hemodynamic trajectories after surgical repair

Year: 2026

Type: article

Abstract: Objective To determine whether tricuspid leaflet multiplicity is associated with divergent postoperative hemodynamic trajectories after surgical repair. Methods One hundred seventeen patients undergoing tricuspid valve surgery (January 2023 to March 2025) were prospectively enrolled, with leaflet morphology classified by intraoperative visualization and serial echocardiography over 1 year. The prespecified primary end point was a Doppler-derived tricuspid regurgitation pressure gradient (TRPG) increase, defined as a 5-mm Hg-or-greater increase in TRPG from discharge to 1 year. Results Among 100 patients with paired data, the primary end point occurred more frequently in the 4/5-leaflet group despite similar residual tricuspid regurgitation (TR) and discharge TRPG (48.5% vs 26.9%; odds ratio, 2.56; 95% CI, 1.07-6.12; P = .034); the age-adjusted association was borderline (aOR, 2.39; P = .054) and the within-group rise significant only in that cohort ( P = .024). Severe-or-greater TR recurrence was rare (3.0% vs 0.0%; P = .327). Discharge tricuspid annular plane systolic excursion was lower in the 4/5-leaflet group (0.96 ± 0.36 vs 1.15 ± 0.36 cm; P = .010) but converged by 1 year ( P = .585). Conclusions Tricuspid leaflet multiplicity was associated with a subphenotype showing preserved early TR reduction, lower discharge tricuspid annular plane systolic excursion, and a greater 1-year frequency of Doppler-derived TRPG increase. Morphology-based stratification may refine postoperative surveillance pending external validation.

Source: JTCVS Open

DOI: 10.1016/j.xjon.2026.102089