Impact of tricuspid regurgitation on postoperative outcomes after non-cardiac surgeries

Abstract

ObjectiveTricuspid regurgitation (TR) severity has known adverse implications, its impact on patients undergoing non-cardiac surgery (NCS) remains unclear. We sought to determine the impact of TR on patient outcomes after NCS.MethodsWe performed a retrospective cohort study in patients undergoing NCS. Outcomes in patients with moderate or severe TR were compared with no/trivial TR after adjusting for baseline characteristics and revised cardiac risk index (RCRI). The primary outcome was defined as 30-day mortality and heart failure (HF), while the secondary outcome was long-term mortality.ResultsOf the 7064 patients included, 312 and 80 patients had moderate and severe TR, respectively. Thirty-day mortality was higher in moderate TR (adjusted OR 2.44, 95% CI 1.25 to 4.76) and severe TR (OR 2.85, 95% CI 1.04 to 7.79) compared with no/trivial TR. There was no difference in 30-day HF in patients with moderate TR (OR 1.48, 95% CI 0.90 to 2.44) or severe TR (OR 1.42, 95% CI 0.60 to 3.39). The adjusted HR for long-term mortality in moderate TR was 1.55 (95% CI 1.31 to 1.82) and 1.87 (95% CI 1.40 to 2.50) for severe TR compared with no/trivial TR.ConclusionIncreasing TR severity has higher postoperative 30-day mortality in patients undergoing NCS, independent of RCRI risk factors, ejection fraction or mitral regurgitation. Severity of TR should be considered in risk stratification for patients undergoing NCS.

Preoperative Echocardiographic Unknown Valvopathy Evaluation in Elderly Patients Undergoing Neuraxial Anesthesia during Major Orthopedic Surgery: A Mono-Centric Retrospective Study

“…Not all valvular pathologies are clinically significant; mild mitral or tricuspid valve diseases need only a change in lifestyle, according to the most recent guidelines [ 28 , 39 ]. Patients with moderate–severe tricuspid insufficiency had a greater risk of mortality and morbidity 1 month after surgery, not correlated with RCRI scores or ejection fraction [ 50 ]. Moreover, severe aortic stenosis is associated with a higher risk of MACEs at 1 month after surgery (18.8%), whether symptomatic or not; the risk of mortality due to MACE was similar if correlated with class I or II of RCRI score and increased only with an RCRI score > 2 [ 51 ].…”

Echocardiography in the Assessment of Valve Regurgitation– Incremental Role of Three Dimensional Echocardiography

“…The guidelines are therefore not predicated on cumulative evidence [ 25 , 26 ]. Many recent studies have suggested that early surgery is better since it improves short- and long-term post-operative outcomes [ 27 , 28 , 29 ]. A prior study suggested that restoring normal life expectancy did not occur even in patients with NYHA class II symptoms [ 30 ], emphasizing the need for TR surgical management before heart failure symptoms develop [ 31 ].…”