Concomitant tricuspid valve surgery is beneficial at the time of left‐sided valve surgery

Abstract

Background This study evaluates the impact of secondary functional tricuspid regurgitation (TR) and concomitant tricuspid valve repair (TVr) at the time of left‐sided valve operations. Methods Adults undergoing left‐sided valve operations between 2010 and 2019 at a multihospital academic institution were included. Patients were stratified into three groups: less‐than‐moderate TR without TVr (Group 1), moderate‐or‐greater TR without TVr (Group 2), and moderate‐or‐greater TR with TVr (Group 3). Primary outcomes included survival and hospital readmissions. Secondary outcomes included major postoperative morbidities. Multivariable logistic regression evaluated risk‐adjusted mortality and readmission. Results About 3444 patients were included in the analysis and were stratified into Group 1 (n = 2612, 75.8%), Group 2 (n = 563, 16.3%), and Group 3 (n = 269, 7.8%). Patients with moderate or greater TR (Groups 2 and 3) had higher rates of mortality, hospital readmissions and major postoperative complications including reoperations, renal failure requiring dialysis, blood transfusions, and prolonged ventilation (all, p < .05). When assessed individually, the Group 3 had substantially higher rates of renal failure requiring dialysis, prolonged ventilation, and reoperations, although the Group 2 had higher rates of 30‐day mortality (all, p < .05). These findings persisted in risk‐adjusted analysis with the highest hazards for mortality (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.7–2.2) and readmission (HR 1.3, 95% CI 1.2–1.5) appreciated in the Group 2. Conclusions In this analysis of 3444 patients, those with moderate‐to‐severe TR who did not undergo a TVr at the time of their left‐sided valve operation had substantially higher risks of mortality and hospital readmissions compared with those who did undergo TV surgery.

In the operating room, do not leave important things unattended

“…Guess we still have no strong answers to many other questions. There is growing information that TVr plays a role in preventing mortality and improving outcomes in left‐sided valvular surgery, 3,4 something which is supported in this current Huckaby et al 1 contribution. This is most likely due to the control of regurgitation with positive impact on right ventricular function and pulmonary pressure.…”

“…In this issue of the Journal of Cardiac Surgery , Huckaby et al 1 aimed at evaluating the impact of secondary functional tricuspid regurgitation (STR) and concomitant tricuspid valve repair (TVr) when operating left‐sided valves. All patients undergoing left‐sided valve surgery between 2010 and 2019 were retrospectively reviewed and grouped concerning the degree of TR and associated TVr.…”

“…Another topic of interest derived from this contribution 1 is the old problem of what to do in the tricuspid valve. Huckaby et al 1 confirmed that they only performed partial annuloplasty ring repairs. Not confirmed if rigid, flexible or semi‐rigid.…”

“…In the end, STR has been identified as a growing problem in recent years due to missconceptions 12 . To summarize, Huckaby et al 1 have brought again the attention of the readership to a still active and unsolved problem. They highlight the impact of TR on outcomes among patients undergoing left‐sided valve operations, aortic and mitral as they pooled all together, which might be a matter of discussion.…”

Commentary: Is it the tricuspid valve, is it the right ventricle? Have we improved?

“…Recent contributions addressed this problem, [5][6][7] although with slightly less-sophisticated analytical methods. The chronic misconceptions on functional tricuspid regurgitation 2 are now being clarified, especially in a time when much investigation and investment goes into the transcatheter approach to the TV, both for percutaneous repair and replacement.…”