The Impact of Diastolic Dysfunction on Postoperative Tricuspid Regurgitation and Heart Failure Readmission in Patients with Severe Aortic Stenosis

Objectives: A clinical significance of left ventricular diastolic dysfunction (LVDD) in patients with severe aortic stenosis (AS) is not fully elucidated. This study sought to evaluate the impact of LVDD on postoperative tricuspid regurgitation and heart failure readmission after aortic valve replacement (AVR) for severe AS. Methods and Results: From January 2007 to December 2016, we consecutively enrolled 101 patients undergoing isolated AVR (+CABG) for severe AS. Patients with LVDD (E/E' ≥15) were compared with those without LVDD (E/E' <15). Patients with LVDD showed significant difference in the frequency of postoperative tricuspid regurgitation more than mild 1, 3, and 5 years after surgery (P = .023, 0.046, and 0.025, respectively). Kaplan-Meier analysis showed that patients with LVDD had a significantly higher rate of heart failure readmission (P = .023) compared with those without LVDD. A multivariate Cox hazards model showed that the independent predictors of heart failure readmission were dialysis (adjusted hazard ratio 5.094, 95% confidence interval 1.654 to 15.690, P = .005) and persistent atrial fibrillation (adjusted hazard ratio 19.158, 95% confidence interval 1.677 to 218.822, P = .017). Conclusions: Presence of preoperative diastolic dysfunction was associated with postoperative tricuspid regurgitation and heart failure readmission. Especially, patients with dialysis or atrial fibrillation have a higher risk of heart failure readmission.