Long-term outcomes of concomitant tricuspid valve repair in patients undergoing mitral valve surgery

Abstract

Background We aimed to find out how the concomitant performance of tricuspid valve repair (TVR) affects outcomes of patients undergoing mitral valve surgery (MVS). Methods Single-centre, retrospective analysis of 1357 patients who underwent MVS between January 2005 and December 2015, including 1165 patients with isolated MVS and 192 patients with MVS plus TVR. We used propensity scores to match patients for baseline characteristics other than valve related parameters and arrived at a matched sample of 182 patients per group. Results The overall procedure duration was longer in the MVS + TVR (224 min) versus the MVS group (176 min; p < 0.001), as were the duration of mechanical ventilation (13 vs. 11 h; p < 0.001), X-clamp (90.5 vs. 66 min; p < 0.001) and cardiopulmonary bypass time (136 vs. 95.5 min; p < 0.001). Rates of procedural complications were not different between groups with the exception of pacemaker rates which were 16.0% in the MVS + TVR group and 8.8% in the isolated MVS group ( p = 0.037). There was no difference in death rates within 30 days, stroke, myocardial infarction or repeat MVS. The long-term survival rate was 60.8% in the MVS + TVR vs. 57.5% in the isolated MVS group (HR 1.048; 95%CI 0.737–1.492; p = 0.794). The rate of grade III/IV tricuspid regurgitation (TR) remained low after MVS + TVR during long-term follow-up while the rate of grade ≥ II TR increased slightly in the isolated MVS group. Conclusion The data show that the concomitant performance of TVR in patients undergoing MVS is a safe and effective procedure with good long-term outcomes. Patients can undergo MVS + TVR with confidence as it improves their prognosis up to the level of patients undergoing isolated MVS.

The influence of mitral valve pathology on the concomitant tricuspid valve repair

“…23 Several studies found improved outcomes after repairing moderate or less degree TR concomitant with MV surgery. 16,24,25 The progression of postoperative TR was proportional to the preoperative TR grade.…”

Does concomitant tricuspid valve surgery increase the risks of minimally invasive mitral valve surgery? A multicentre comparison based on data from The Netherlands Heart Registration

“…After matching no difference in 30-day and 120-day mortality were found and the postoperative complication rates were similar between the groups. The median length of hospital stay was longer in the MIDVS group (9 days [6][7][8][9][10][11][12][13] vs. 7 days [6][7][8][9][10][11]; p = .04) in the SDV group. (Table 4) Kaplan-Meier analyses in the matched population showed no significant difference between MIDVS and SDV (94.7% vs. 93.3%, Log-Rank p = .62 Figure 1B).…”

“…No differences in 30-day mortality (n = 0 [0] vs. n = 5 [0.7]; p = .99) and 120-day mortality (n = 1 [1.2] vs. n = 7 [1.0]; p = .99) were observed (Table S1). A longer median hospital stay (9 days [6][7][8][9][10][11][12][13] vs. 6 days [5][6][7][8]; p < .001), a higher incidence of new onset arrythmia (n = 39 [45.3] vs. n = 134 [19.4]; p < .001) and higher need for re-exploration of bleeding (n = 12 [14.0] vs. n = 30 [4.4]; p = .001) was observed for MIDVS in the unmatched population compared with MIMVS (see Table S1).…”

“…minimally invasive double valve group (9 days [6][7][8][9][10][11][12][13]) compared with sternotomy (7 days [6][7][8][9][10][11]; p = .04).…”

Three dimensional modeling of atrioventricular valves provides predictive guides for optimal choice of prosthesis

“…Concomitant tricuspid valve disease is not uncommon. Mitral and/or tricuspid intervention may entail increased procedural complexities 1 , 2 .…”