Preoperative factors associated with adverse outcome after tricuspid valve replacement

Yan Topilsky, Amber D. Khanna, Jae Kuen Oh, Rick A. Nishimura, Maurice E Sarano, Yang B. Jeon, Thoralf M. Sundt, Hartzell V Schaff, Soon J. Park

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Background-: Preoperative factors associated with increased mortality and worse outcome after tricuspid valve replacement in patients with severe tricuspid regurgitation are poorly understood. Methods and Results-: We retrospectively analyzed 189 patients (37% men; age, 67.5±11.3 years) who underwent tricuspid valve replacement for severe tricuspid regurgitation. Operative mortality rate was 10%, and was associated with intra-aortic balloon pump (odds ratio, 3.2; 95% confidence interval, 1.9 to 5.6; P<0.0001) or the presence of severe symptoms (New York Heart Association class IV relative to classes II and/or III) at the time of surgery (1.7; 95% confidence interval, 1.05 to 2.8; P=0.02). At the end of follow-up (29.3±27.1 months), 70 patients (37%) died, 6 (3%) needed tricuspid reoperation, and 41 (21.7%) were readmitted for heart failure. Seventy-eight patients (41.3%) were free from cardiovascular events (death, tricuspid reoperation, or heart failure admissions). The only echocardiographic parameter independently associated with adverse outcomes was a decrease in the right index of myocardial performance ratio. All-cause mortality was independently associated with a higher Charlson index (hazard ratio, 1.18; 95% confidence interval, 1.01 to 1.36; P=0.03), shorter right index of myocardial performance ratio (0.91; 95% confidence interval, 0.87 to 0.96; P=0.005), and preoperative New York Heart Association IV class (1.71; 95% confidence interval, 1.3 to 2.2; P<0.0001). In 68 patients with isolated tricuspid valve replacement, the associations between short right index of myocardial performance ratio, high Charlson index, New York Heart Association class IV, and increased mortality remained significant. Conclusions-: Tricuspid valve replacement for severe tricuspid regurgitation can be performed with an acceptable operative mortality if patients undergo surgery before the onset of advanced heart failure symptoms. Late mortality is associated with a high preoperative Charlson index, short right index of myocardial performance ratio, and advanced New York Heart Association class.

Original languageEnglish (US)
Pages (from-to)1929-1939
Number of pages11
JournalCirculation
Volume123
Issue number18
DOIs
StatePublished - May 10 2011

Fingerprint

Tricuspid Valve
Tricuspid Valve Insufficiency
Confidence Intervals
Mortality
Heart Failure
Reoperation
Odds Ratio

Keywords

  • echocardiography
  • tricuspid valve
  • tricuspid valve insufficiency

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Preoperative factors associated with adverse outcome after tricuspid valve replacement. / Topilsky, Yan; Khanna, Amber D.; Oh, Jae Kuen; Nishimura, Rick A.; Sarano, Maurice E; Jeon, Yang B.; Sundt, Thoralf M.; Schaff, Hartzell V; Park, Soon J.

In: Circulation, Vol. 123, No. 18, 10.05.2011, p. 1929-1939.

Research output: Contribution to journalArticle

Topilsky, Yan ; Khanna, Amber D. ; Oh, Jae Kuen ; Nishimura, Rick A. ; Sarano, Maurice E ; Jeon, Yang B. ; Sundt, Thoralf M. ; Schaff, Hartzell V ; Park, Soon J. / Preoperative factors associated with adverse outcome after tricuspid valve replacement. In: Circulation. 2011 ; Vol. 123, No. 18. pp. 1929-1939.
@article{f230cb7232b9405ab939ed62a83b5df0,
title = "Preoperative factors associated with adverse outcome after tricuspid valve replacement",
abstract = "Background-: Preoperative factors associated with increased mortality and worse outcome after tricuspid valve replacement in patients with severe tricuspid regurgitation are poorly understood. Methods and Results-: We retrospectively analyzed 189 patients (37{\%} men; age, 67.5±11.3 years) who underwent tricuspid valve replacement for severe tricuspid regurgitation. Operative mortality rate was 10{\%}, and was associated with intra-aortic balloon pump (odds ratio, 3.2; 95{\%} confidence interval, 1.9 to 5.6; P<0.0001) or the presence of severe symptoms (New York Heart Association class IV relative to classes II and/or III) at the time of surgery (1.7; 95{\%} confidence interval, 1.05 to 2.8; P=0.02). At the end of follow-up (29.3±27.1 months), 70 patients (37{\%}) died, 6 (3{\%}) needed tricuspid reoperation, and 41 (21.7{\%}) were readmitted for heart failure. Seventy-eight patients (41.3{\%}) were free from cardiovascular events (death, tricuspid reoperation, or heart failure admissions). The only echocardiographic parameter independently associated with adverse outcomes was a decrease in the right index of myocardial performance ratio. All-cause mortality was independently associated with a higher Charlson index (hazard ratio, 1.18; 95{\%} confidence interval, 1.01 to 1.36; P=0.03), shorter right index of myocardial performance ratio (0.91; 95{\%} confidence interval, 0.87 to 0.96; P=0.005), and preoperative New York Heart Association IV class (1.71; 95{\%} confidence interval, 1.3 to 2.2; P<0.0001). In 68 patients with isolated tricuspid valve replacement, the associations between short right index of myocardial performance ratio, high Charlson index, New York Heart Association class IV, and increased mortality remained significant. Conclusions-: Tricuspid valve replacement for severe tricuspid regurgitation can be performed with an acceptable operative mortality if patients undergo surgery before the onset of advanced heart failure symptoms. Late mortality is associated with a high preoperative Charlson index, short right index of myocardial performance ratio, and advanced New York Heart Association class.",
keywords = "echocardiography, tricuspid valve, tricuspid valve insufficiency",
author = "Yan Topilsky and Khanna, {Amber D.} and Oh, {Jae Kuen} and Nishimura, {Rick A.} and Sarano, {Maurice E} and Jeon, {Yang B.} and Sundt, {Thoralf M.} and Schaff, {Hartzell V} and Park, {Soon J.}",
year = "2011",
month = "5",
day = "10",
doi = "10.1161/CIRCULATIONAHA.110.991018",
language = "English (US)",
volume = "123",
pages = "1929--1939",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "18",

}

TY - JOUR

T1 - Preoperative factors associated with adverse outcome after tricuspid valve replacement

AU - Topilsky, Yan

AU - Khanna, Amber D.

AU - Oh, Jae Kuen

AU - Nishimura, Rick A.

AU - Sarano, Maurice E

AU - Jeon, Yang B.

AU - Sundt, Thoralf M.

AU - Schaff, Hartzell V

AU - Park, Soon J.

PY - 2011/5/10

Y1 - 2011/5/10

N2 - Background-: Preoperative factors associated with increased mortality and worse outcome after tricuspid valve replacement in patients with severe tricuspid regurgitation are poorly understood. Methods and Results-: We retrospectively analyzed 189 patients (37% men; age, 67.5±11.3 years) who underwent tricuspid valve replacement for severe tricuspid regurgitation. Operative mortality rate was 10%, and was associated with intra-aortic balloon pump (odds ratio, 3.2; 95% confidence interval, 1.9 to 5.6; P<0.0001) or the presence of severe symptoms (New York Heart Association class IV relative to classes II and/or III) at the time of surgery (1.7; 95% confidence interval, 1.05 to 2.8; P=0.02). At the end of follow-up (29.3±27.1 months), 70 patients (37%) died, 6 (3%) needed tricuspid reoperation, and 41 (21.7%) were readmitted for heart failure. Seventy-eight patients (41.3%) were free from cardiovascular events (death, tricuspid reoperation, or heart failure admissions). The only echocardiographic parameter independently associated with adverse outcomes was a decrease in the right index of myocardial performance ratio. All-cause mortality was independently associated with a higher Charlson index (hazard ratio, 1.18; 95% confidence interval, 1.01 to 1.36; P=0.03), shorter right index of myocardial performance ratio (0.91; 95% confidence interval, 0.87 to 0.96; P=0.005), and preoperative New York Heart Association IV class (1.71; 95% confidence interval, 1.3 to 2.2; P<0.0001). In 68 patients with isolated tricuspid valve replacement, the associations between short right index of myocardial performance ratio, high Charlson index, New York Heart Association class IV, and increased mortality remained significant. Conclusions-: Tricuspid valve replacement for severe tricuspid regurgitation can be performed with an acceptable operative mortality if patients undergo surgery before the onset of advanced heart failure symptoms. Late mortality is associated with a high preoperative Charlson index, short right index of myocardial performance ratio, and advanced New York Heart Association class.

AB - Background-: Preoperative factors associated with increased mortality and worse outcome after tricuspid valve replacement in patients with severe tricuspid regurgitation are poorly understood. Methods and Results-: We retrospectively analyzed 189 patients (37% men; age, 67.5±11.3 years) who underwent tricuspid valve replacement for severe tricuspid regurgitation. Operative mortality rate was 10%, and was associated with intra-aortic balloon pump (odds ratio, 3.2; 95% confidence interval, 1.9 to 5.6; P<0.0001) or the presence of severe symptoms (New York Heart Association class IV relative to classes II and/or III) at the time of surgery (1.7; 95% confidence interval, 1.05 to 2.8; P=0.02). At the end of follow-up (29.3±27.1 months), 70 patients (37%) died, 6 (3%) needed tricuspid reoperation, and 41 (21.7%) were readmitted for heart failure. Seventy-eight patients (41.3%) were free from cardiovascular events (death, tricuspid reoperation, or heart failure admissions). The only echocardiographic parameter independently associated with adverse outcomes was a decrease in the right index of myocardial performance ratio. All-cause mortality was independently associated with a higher Charlson index (hazard ratio, 1.18; 95% confidence interval, 1.01 to 1.36; P=0.03), shorter right index of myocardial performance ratio (0.91; 95% confidence interval, 0.87 to 0.96; P=0.005), and preoperative New York Heart Association IV class (1.71; 95% confidence interval, 1.3 to 2.2; P<0.0001). In 68 patients with isolated tricuspid valve replacement, the associations between short right index of myocardial performance ratio, high Charlson index, New York Heart Association class IV, and increased mortality remained significant. Conclusions-: Tricuspid valve replacement for severe tricuspid regurgitation can be performed with an acceptable operative mortality if patients undergo surgery before the onset of advanced heart failure symptoms. Late mortality is associated with a high preoperative Charlson index, short right index of myocardial performance ratio, and advanced New York Heart Association class.

KW - echocardiography

KW - tricuspid valve

KW - tricuspid valve insufficiency

UR - http://www.scopus.com/inward/record.url?scp=79955750884&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79955750884&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.110.991018

DO - 10.1161/CIRCULATIONAHA.110.991018

M3 - Article

VL - 123

SP - 1929

EP - 1939

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 18

ER -