Long-term outcomes of patients undergoing tricuspid valve surgery

Nishant Saran, Joseph Dearani, Sameh Said, Kevin L. Greason, Alberto Pochettino, John M. Stulak, Simon Maltais, Sertac Cicek, Juan Crestanello, Richard C Daly, Katherine S. King, Hartzell V. Schaff

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

OBJECTIVES: Limited literature is available on the best management strategy for tricuspid valve (TV) disease in adults. We sought to review our long-term outcomes of TV surgery with regard to survival and reoperation. METHODS: A retrospective analysis of all patients ≥18 years of age [n = 2541, aged 67 ± 13years, 1433 (56%) females] who underwent first-time TV surgery between January 1993 and December 2013 was done. There were 1735 patients who received TV repair and 806 patients underwent replacement. A gradient boosting machine model was used to derive a propensity score for predicting replacement using 27 preoperative characteristics. Four hundred and eighteen propensity-matched pairs of TV repair and replacement were identified. Cox proportional hazard regression was used on the matched subset to determine the effect of replacement. RESULTS: Functional TV regurgitation was present in 54% (n = 1369). A bioprosthesis was used in 84% (n = 680) of replacements, while 54% (n = 934) of TV repairs were ring annuloplasties. Operative mortality was 8% (n = 212). Overall survival was 54%, 29% and 13% at 5, 10 and 15 years, respectively. After propensity score matching, replacement was significantly associated with increased mortality [hazard ratio (HR) 1.54, 95% confidence interval (CI) 1.18-2.00; P = 0.001]. The cumulative incidence of TV reoperation was similar between the 2 groups when accounting for the competing risk of death [Fine-Gray HR 1.56, 95% CI 0.9-2.8; P = 0.144]. CONCLUSIONS: TV surgery is associated with poor outcomes due to multiple patient comorbidities. TV repair results in better survival compared to replacement in patients with similar comorbidities with no increased risk of getting a reoperation.

Original languageEnglish (US)
Pages (from-to)950-958
Number of pages9
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume56
Issue number5
DOIs
StatePublished - Nov 1 2019

Keywords

  • Propensity-matched analysis
  • Tricuspid valve
  • Tricuspid valve repair
  • Tricuspid valve replacement

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Long-term outcomes of patients undergoing tricuspid valve surgery'. Together they form a unique fingerprint.

  • Cite this

    Saran, N., Dearani, J., Said, S., Greason, K. L., Pochettino, A., Stulak, J. M., Maltais, S., Cicek, S., Crestanello, J., Daly, R. C., King, K. S., & Schaff, H. V. (2019). Long-term outcomes of patients undergoing tricuspid valve surgery. European Journal of Cardio-Thoracic Surgery, 56(5), 950-958. https://doi.org/10.1093/ejcts/ezz081