Tricuspid Annular Remodeling in Tachycardia Induced Cardiomyopathy with Functional Tricuspid Regurgitation.

Document Type

Article

Publication Date

12-2025

Publication Title

Journal of Thoracic and Cardiovascular Surgery

Abstract

OBJECTIVES: Surgical repair of severe functional tricuspid regurgitation (FTR) is associated with high rates of residual and recurrent insufficiency. We set out to investigate tricuspid annular remodeling in awake intact sheep with FTR to better guide surgical repair.

METHODS: Fifteen adult male sheep underwent right thoracotomy, echocardiography, epicardial pacemaker implantation, and cardiopulmonary bypass for placement of sonomicrometry crystals around the tricuspid annuls (TA) and on the right ventricular epicardium. After 8 ± 2 days recovery, 8 surviving animals underwent baseline sonomicrometry data acquisition while awake and standing in the pen. Subsequently, animals were paced for a mean of 18 ± 2 days at a rate of 180 to 240 beats/min until the development of tachycardia-induced cardiomyopathy and tricuspid insufficiency. With the pacer off, sonomicrometry data were obtained again in conscious animals (FTR). TA geometry and regional annular segment lengths were calculated from 3-dimensional crystal coordinates.

RESULTS: Our ovine tachycardia-induced cardiomyopathy model was associated with moderate-to-severe FTR and enlargement of right ventricular volume of 48%, TA area of 57%, and TA perimeter of 24%, all reflective of clinical FTR. With FTR, anterior, posterior, and septal tricuspid annular perimeters dilated by 27%, 17%, and 25%, respectively (all P < .01). TA area reduction during the cardiac cycle decreased from 16.6 ± 6.3% to 4.5 ± 4.2% with FTR (P = .52).

CONCLUSIONS: In intact awake sheep with moderately severe FTR, all tricuspid annular segments dilated, including significant enlargement of the septal annulus. These data suggest improved technical and prosthetic designs to better support the septal annulus may potentially achieve more reliable and durable repair of severe FTR.

DOI

10.1016/j.jtcvs.2025.12.008

ISSN

1097-685X

PubMed ID

41391630

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