Background: In pericardiectomy for constrictive pericarditis, postoperative worsening of tricuspid regurgitation (TR) is a problem to be considered. It is a focus of attention and there are several case reports and studies concerning this phenomenon.
Aim: The aim of this review was to examine available literature with regard to worsening of TR after pericardiectomy in order to clarify its incidence, mechanism, long-term outcome, and preventive measures.
Results: About one-third to half of patients experience an increase in TR postoperatively without tricuspid valve intervention. Postoperative right ventricular (RV) dilatation, tricuspid annular dilatation, together with perioperative RV dysfunction play the major role. The preoperative existence of TR increased mortality in large studies, and worsened TR postoperatively had a trend toward reduced survival. Whether tricuspid valve intervention improves outcome or not is still to be determined. At least, this intervention appears protective against long-term mortality. Radical pericardiectomy seems to have the possibility to improve the outcome related to TR than conventional pericardiectomy.
Conclusions: The findings of this review can be summarized as: 1. In pericardiectomy for constrictive pericarditis, preoperative TR and its postoperative worsening cannot be ignored. 2. Concomitant tricuspid valve intervention has a tendency toward improved long-term survival and should be considered especially in cases with preoperative TR. 3. Regarding TR, radical pericardiectomy seems to have more benefit than conventional pericardiectomy.
Keywords: Pericardiectomy, constrictive pericarditis, tricuspid regurgitation, tricuspid valve intervention, radical pericardiectomy