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ONE YEAR FOLLOW UP OF TRICUSPID ANULUS

PLANE SYSTOLIC EXCURTION (TAPSE) IN


RHEUMATIC HEART DISEASE PATIENTS WHO
UNDERGONE SURGICAL VALVE REPLACEMENT
Nabila Natasya, S.Ked
Department of Cardiovascular, Thoracic and Endovascular Surgery Sanglah
Central Hospital – Udayana University, Bali- Indonesia
Background
There are estimated 15 million cases of RHD worldwide dominated in
developing country

There’re no exact data about RHD prevalence in Indonesia, but its estimated
there’re about 0.3-0.8 cases per 1000 people

Around 28-300 surgical valve replacement perform per year in Indonesia

Sanglah central hospital is the only hospital that can performed surgical valve
replacement around East Indonesian
Why TAPSE?
TAPSE represented right
heart function in
echocardiography

RVF have high prevalence of


morbidity and mortality

There’s still a few literature


available on RVF in context of
cardiac surgery
Method
Location of research :
• Sanglah General Hospital. Denpasar. Bali

Time of research :
• September 2017 – December 2017

Sample :
• 101 participants registered from 2012-2017
• Underwent surgical valve replacement at Sanglah General
Hospital
Method
Research method :
• Single center cohort study, with follow up for 1 year
• Bivariate analysis measure using chi-square
• Multivariate analysis and survival measure using cox-regression

Data collection :
• Secondary data ; Medical record
• Demographic data
• Echocardiography pre operative
• Echocardiography post operative
• Surgical Detail (types of technique, total time, ACC time, CPB time,
and type of prosthetic valve that we used)
Result : Patients Characteristics
Pulmonary Hipertention Total
Characteristic
No PH 64 Persen
63.4 (%)
(N=101)
Mild PH 19 18.8
Female
Moderategender
PH 64
9 63.4
8.9
Elevated JVP
Severe PH 33
9 32.7
8.9
LVEF (%)Fibrilation
Atrial 42 41.6
Normal EF (>55) 87 86.1
AF NVR
Midrange EF (40-55)
30
13
29.7
12.9
AFEF
Low RVR(<40) 12
1 40.6
1.0
LVIDD (cm)
TAPSE (cm)
Normal TAPSE (>1.6) 66 65.3
Normal (3.9-5.3) 74 73.3
Low TAPSE (<1.6) 35 34.7
Type Mildly
of SurgeryDilated (5.4-5.7) 6 5.9
Moderately Dilated (5.8-6.1)
MVR 7
51 6.9
50.5
MVR + Tvr Dilated (>6.2)
Severely 13
14 12.9
13.9
MVR + Tvr + LAA Lig 9 8.9
LA Diameter (cm)
DVR 24 23.8
Normal
DVR + Tvr (2.8-4.0) 47
4 46.5
4.0
Type Midly
of ValveDilated (4.1-4.6) 14 13.9
Mechanical
Moderately ValveDilated (4.7-5.2) 68
3 67.3
3.0
Bio prosthesis Valve 33 32.7
Severely Dilated >5.2
Time for ACC used
37 36.6
E\A< 2.5
Ratio
hours 86 85.1
 Normal
2.5 Hoursor Pseudonormal (1-2) 50
15 49.5
14.9
Time for CPB used
Delayed Relaxation (<1) 32 31.7
< 4 hours 97 96
 Restrictive
4 Hours Filling (>2) 19
4 18.8
4.0
Result : TAPSE 12 months after surgery

Variables Mean Mean p 95% Confidence


An improvement in right
Pre Post Interval
Surgery Surgery
heart function a year after
TAPSE 1.69 1.86 0.000 -0.60 -0.10
surgery measure by TAPSE,
statically significant (p=0.000)
Result : Factors Affecting One Year Post-
OP TAPSE
95.0% CI
Independent Variables p value RR Lower Upper
Older Age .041* 3.043 1.961 9.737
Female Gender .426 1.328 .423 4.172
Atrial Fibrillation Status .229 .523 0.445 5.410
Elevated Pre-op JVP .000* 14.083 3.645 54.41
Heart Rate .229 .311 .38 25240
EF Pre-Op .068 1.134 .014 3.341
Dilated LVIDD Pre-Op .007* 2.889 .263 3.070
Dilated LA Diam Pre-Op .006* 2.475 .792 7.736
Abnormal E/A Pre-Op .001* 1.316 .449 3.858
Pulmonary Hypertension status .223 .525 .315 41.12
Total Time Needed for Procedure (>5 hours) .301 .712 .908 1.006
ACC time (>2.5 hours) .042* 1.404 1..003 5.570
CPB Machine time (>4 hours) .504 1.822 .177 18.71
Complex Procedure (DVR, Valve replacement + 2.871
.033* .031 3.141
LAA ligation)
Mechanical Valve Phrosthesis .045* 2.400 1.811 7.105
Conclusion
Valve replacement can improve TAPSE in RHD Patients
Significantly

Some factors affecting TAPSE 12 months post surgical


replacement such as : age, JVP, LVIDd, LAdiam, E/A tyoe
of procedure and type of valve used

The findings from this study can be used to predict


prognosis of RHD patients that will be going to surgical
valve replacement Better patients selection and
improving surgical tecnique will give benefit to RV
function improvement
Thank you