Right ventricular function in marfan patients remains stable despite multiple cardiac interventions.

Mihalj, Maks; Nucera, Maria; Ferro, Cyril; Mosbahi, Selim; Haynes, Alan; Yildiz, Murat; Heinisch, Paul Philipp; Schoenhoff, Florian S (2024). Right ventricular function in marfan patients remains stable despite multiple cardiac interventions. European journal of cardio-thoracic surgery, 66(3) Oxford University Press 10.1093/ejcts/ezae313

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OBJECTIVES

Mitral valve regurgitation and left ventricular dysfunction are cardiovascular symptoms of Marfan syndrome. There is a paucity of information on tricuspid valve regurgitation and right ventricular function. In patients with Marfan syndrome, we looked at long-term changes in right ventricular function, tricuspid valve regurgitation, and freedom from tricuspid valve repair.

METHODS

Retrospective-observational single-centre analysis on right ventricular function and tricuspid regurgitation in Marfan patients who underwent surgery with cardioplegic arrest between 1995 and 2020. Patients were followed-up from first operation until death, with echocardiographic changes analysed longitudinally. Composite end-point was TAPSE ≤ 16mm, severe tricuspid regurgitation, or tricuspid repair.

RESULTS

The study included 135 patients who underwent 193 operations, 58 of those were reoperations in 40 patients. Median age at first operation was 35 years (IQR 26-46), median follow-up was 8.0 years (IQR 3.0-16.0), and median time-to-first-reoperation was 7.5 years (IQR 3.4-12.5). The composite end-point occurred in 81 observations in 40 patients, mostly as a recurrent event, after median 7.0 years (IQR 1.0-13.0). 10-year-cumulative-incidence for composite end-point was 22.0% (95% CI 15-31), and 9.0% (95% CI 4.4-16) for new-onset TAPSE ≤ 16mm, but no significant change in TAPSE was observed at 10 years. Tricuspid regurgitation was associated with increased risk of annual progression (P < 0.001), but not clinically relevant at 10 years. Actuarial 10-year-survival was 91.1%.

CONCLUSIONS

In Marfan patients with a history of cardiac surgery and subsequent reoperations, the right-ventricular function remains stable. The incidence of severe tricuspid regurgitation and tricuspid repair remain low.

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