Objective To evaluate perioperative right heart form and function in patients with transcatheter tricuspid valve replacement (TTVR) by a variety of transthoracic echocardiography (TTE) indexes.

Methods A total of 28 patients who underwent TTVR for tricuspid regurgitation (n＝25) or artificial tricuspid valve dysfunction (n＝3) in Zhongshan Hospital, Fudan University from September 2021 to February 2023 was retrospectively analyzed. Patient's basic information, history of heart valve surgery, and NYHA cardiac function grade were recorded. TTE imaging data obtained within 7 days before and 30 days after surgery were analyzed to compare the differences in TTE indexes before and after surgery. The patients were then divided into two groups based on the presence or absence of perivalvular leakage (n＝15 and n＝13, respectively) defined by the TTVR device. The differences in TTE index groups before and after surgery were compared.

Results Renato treated 3 cases and LuX-Valve treated 25 cases. The abnormal function of the artificial valves and tricuspid regurgitation were alleviated in all cases after surgery. There were 13 cases (46.4%) that had no perivalvular leakage, 14 cases (50.0%) that had mild perivalvular leakage, and 1 case (3.6%) that had moderate perivalvular leakage. The n-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT) and right ventricular cardiac output (CO) levels were increased compared with those before surgery (P < 0.05). Comparison of TTE indexes in perioperative period: right atrioventricular size, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), inferior caval vein diameter (ICVD) and systolic pulmonary artery pressure (sPAP) were decreased compared with those before surgery (P < 0.05), while left ventricular ejection fraction (LVEF), right atrium (RA) left and right diameter and mean pulmonary artery pressure (mPAP) had no statistical significance compared with those before surgery. Comparison between groups: the left and right diameter of RA in the group with perivalvular leakage after surgery were larger than those in the group without perivalvular leakage (P < 0.05), and there were no significant differences in TTE indexes between the two groups before surgery. There was a moderate positive correlation between FAC (r＝0.541), TAPSE (r＝0.541) and CO (P < 0.05) before surgery.

Conclusions Various TTE indexes have significant reference value in the evaluation of right heart form and function after TTVR surgery, and can provide an objective basis for perioperative clinical decision-making.