TY - JOUR
T1 - Outcomes of tricuspid valve surgery in patients with functional tricuspid regurgitation
AU - Pahwa, Siddharth
AU - Saran, Nishant
AU - Pochettino, Alberto
AU - Schaff, Hartzell
AU - Stulak, John
AU - Greason, Kevin
AU - Daly, Richard
AU - Crestanello, Juan
AU - King, Katherine
AU - Dearani, Joseph
N1 - Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - 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.
AB - 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.
KW - Functional tricuspid regurgitation
KW - Propensity matching
KW - Tricuspid valve repair
KW - Tricuspid valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85099770325&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85099770325&partnerID=8YFLogxK
U2 - 10.1093/ejcts/ezaa350
DO - 10.1093/ejcts/ezaa350
M3 - Article
C2 - 33159792
AN - SCOPUS:85099770325
SN - 1010-7940
VL - 59
SP - 577
EP - 585
JO - European Journal of Cardio-Thoracic Surgery
JF - European Journal of Cardio-Thoracic Surgery
IS - 3
ER -