Operative risk of tricuspid regurgitation (TR) surgery is currently based on right ventricular (RV) systolic function assessment while biological markers of RV congestion are under used. The aim of the study was to assess the additive value of biological markers of RV congestion in predicting postoperative mortality after TR surgery.

Thirty-seven patients (age 69±13 years) referred for surgical correction of isolated severe TR (n=13) or TR associated with a left-side heart valve disease were included. RV congestion was assessed preoperatively using natremia, uremia, creatinin and bilirubin. RV systolic function was assessed by echocardiography using tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change (RVFAC). Outcome was defined as early postoperative mortality (<30 days).

Before surgery, 70% (n=26) patients had moderate to severe TR, 30% (n=11) had RV dysfunction (TAPSE<15mm), and 20% (n=7) both. Bili-rubin level correlated with TAPSE (r=0.43, P=0.04) and inferior vena cava diameter (r=–0.46, P=0.01) but not with TR severity. After cardiac surgery, one patient had persistent moderate to severe TR and 7 patients died. Pre-operative natremia was lower and uremia (20±11 vs. 9±4mmol/L, P=0.0001), creatinin and biliburin were greater in death than survival patients, while no difference was observed for TAPSE, RVFAC, EuroSCORE-II and the severity of TR. Finally, multivariate analysis showed that only uremia (P=0.01) was associated with post-operative mortality.

In patients referred for TR correction, uremia that probably reflects RV congestion appears superior to RV parameters by echocardiography to identify postoperative mortality.