Outcomes of tricuspid valve surgery in patients with functional tricuspid regurgitation

Siddharth Pahwa, Nishant Saran, Alberto Pochettino, Hartzell Schaff, John Stulak, Kevin Greason, Richard C Daly, Juan Crestanello, Katherine King, Joseph Dearani

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

OBJECTIVES: Functional tricuspid regurgitation (fTR) has been amenable to tricuspid valve repair (TVr), with fewer patients needing tricuspid valve replacement (TVR). We sought to review our experience of tricuspid valve surgery for fTR. METHODS: A retrospective analysis of adult patients (≥18 years) who underwent primary tricuspid valve surgery for fTR (n = 926; mean age 68.6 ± 12.5 years; 67% females) from January 1993 through June 2018 was conducted. There were 767 (83%) patients who underwent TVr (ring annuloplasty, 67%; purse-string annuloplasty, 33%) and 159 (17%) underwent TVR (bioprosthetic valves, 87%; mechanical valves, 13%). The median follow-up was 8.2 years [95% confidence interval (CI) 7.2-8.9 years]. RESULTS: A greater proportion of patients who underwent TVR had severe right ventricular dysfunction (P < 0.001), severe tricuspid regurgitation (P < 0.001) and congestive heart failure (P = 0.001) while the TVr cohort had a greater proportion with severe mitral valve (MV) regurgitation (P < 0.001) and concomitant cardiac procedures. Early mortality (TVR, 9% vs TVr, 3%; P = 0.004), renal failure (TVR, 10% vs TVr, 5%; P = 0.014) and hospital stay (TVR, 15 ± 15 days vs TVr, 12 ± 11 days; P < 0.001) were greater in TVR patients. The TVR cohort had worse survival [hazard ratio (HR) 1.57; 95% CI 1.23-1.99]. Multivariable analysis identified congestive heart failure (HR 1.37; 95% CI 1.10-1.72), renal failure (HR 1.79; 95% CI 1.14-2.82), previous MV surgery (HR 1.35; 95% CI 1.05-1.72) and TVR (HR 1.36; 95% CI 1.03-1.79) as independent risk factors for late mortality. CONCLUSIONS: Tricuspid repair for fTR appears to have better early and late outcomes. Since previous MV surgery and TVR are identified as independent risk factors for late mortality, concomitant TVr at the time of index MV surgery may be considered. Early referral before the onset of advanced heart failure may improve outcomes.

Original languageEnglish (US)
Pages (from-to)577-585
Number of pages9
JournalEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume59
Issue number3
DOIs
StatePublished - Apr 13 2021

Keywords

  • Functional tricuspid regurgitation
  • Propensity matching
  • Tricuspid valve repair
  • Tricuspid valve replacement

ASJC Scopus subject areas

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

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