Through this study, we investigated the relationship
between the TAPSE/PASP ratio and in-hospital
mortality of surgically treated TV disease. Noteworthy
this research highlights:
- TAPSE/PASP ratio is an independent predictor
of in-hospital mortality in patients, who underwent
TV surgery.
- Advanced age is an independent rick factor of
in-hospital mortality in such patient group. With
regard to the current knowledge, this present study is
the first data, which represents the relationship with
lower TAPSE/PASP ratio and in-hospital mortality in
this patient group in literature.
Open repair or replacement of the TV is a
high-risk operation. Kawsara et al.[6] have recently
represented that 8.7% of surgically treated patients
have in-hospital mortality. In the same data, acute
heart failure signs and symptoms, nonelective
surgery, and liver dysfunction were shown to be
the independent predictors of in-hospital mortality.
However, this study was performed in patients with
isolated TV disease. The majority of our patients
underwent surgery due to concomitant valve diseases
or coronary artery.
With regard to long-term mortality, Wong et al.[7]
illustrated that only 12.6% of patients underwent
isolated TV surgery among 2,644 patients. In this
data, it is clearly shown that TV replacement is
an independent predictor of all-cause long-term
mortality. With respect to our findings, there is no clear difference between TV replacement and repair in
term of in-hospital mortality. Long-term findings are
required in our patient group.
The TRI-SCORE is a relatively new score,
which is shown to be an independent predictor of
in-hospital mortality in patients who underwent
surgery due to isolated TV disease. This score
consists of clinical, echocardiographic, and
laboratory parameters, namely advanced age,
clinical status evaluated by the New York Heart
Association system, right-sided heart failure signs
and symptoms, requirement of high-dose loop
diuretics, deterioration of renal status, elevated
total bilirubin, worsening of ejection fraction,
and moderate to severe right ventricular systolic
function.[10] Dreyfus et al.[10] showed that an
advanced TRI-SCORE predicts not only in-hospital
but also one-year mortality in 466 patients who
were surgically treated due to isolated TV disease.
Similarly, advanced age is also an independent risk
factor for our patients. The main difference of our
study is that the vast majority of our patients were
operated on due to concomitant valve and coronary
diseases. Yiu et al.[9] illustrated that right ventricular
mid-cavitary dimensions and increased TV tenting
area predict one-year mortality in 74 patients who
underwent TV surgery due to concomitant valve
disease. According to this study, the right ventricle
diameter and tenting area should be measured
before concomitant valve surgeries.
The TAPSE/PASP ratio is a simple scoring
system based on the echocardiograhic calculations
of TAPSE and PASP. This scoring system has been
shown to be beneficial in various patient groups.
Çolak et al.[12] demonstrated that a TAPSE/PASP
ratio <0.20, combined with worse clinical status, is
related to poor prognosis in patients with chronic
thromboembolic pulmonary hypertension.
In a study with a median follow-up period of
680 days, Maccallini et al.[13] illustrated that an
increased TAPSE/PASP ratio is associated with
increased long-term survival and hospitalizationfree
survival rates in 233 patients with cardiac
amyloidosis. Moreover, among 2,555 patients with
systemic sclerosis, a TAPSE/PASP ratio <0.55
was an independent risk factor of development
for the pulmonary arterial hypertension.[14] The
TAPSE/PASP could be considered a risk factor of
all-cause mortality.[14]
In our data, we aimed to identify the risk factors
of in-hospital mortality in this patient group. Similar
to previous studies, advanced age was shown to be the
independent predictor of in-hospital mortality.[15,16]
This simple, cost-effective, and time-saving method
was shown to be functional in predicting short-term
prognosis in patients who underwent TV surgery. To
the best of our knowledge, this is the first study that
represents such a relationship.
There are several limitations to this study.
First, it was a retrospective study conducted with a
relatively limited number of patients. Second, this
study was performed in a heterogeneous patient
group. The vast majority of studies have been
performed in patients who have been operated
on due to isolated TV disease. Third, long-term
findings of the patients were required. Finally, there
is no clear cutoff value of the TAPSE/PASP ratio in
various patient groups. Further studies are needed to
identify this value.
In conclusion, a decreased TAPSE/PASP ratio is
related to a deterioration in short-term outcomes and
in-hospital mortality in patients who underwent TV
surgery. It is a valid and time-saving scoring system
that can be used daily in clinical practice. The scoring
system can be used to identify high-risk patients,
allowing for more meticulous preoperative and
postoperative evaluations, thereby reducing mortality
rates.
Ethics Committee Approval: The study protocol
was approved by the Mehmet Akif Ersoy Thoracic and
Cardiovascular Surgery Training and Research Hospital
Ethics Committee (date: 27.02.2024, no: 2024.01.13). The
study was conducted in accordance with the principles of the
Declaration of Helsinki.
Patient Consent for Publication: A written informed
consent was obtained from each patient.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Study design, statistics, overwiew:
A.A.; Writing and references: T.A.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: The authors received no financial support for
the research and/or authorship of this article.
){kind=link}
){kind=link}
){kind=link}
){kind=link}
){kind=link}