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, 67.5Ϯ11.3 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; PϽ0.0001) 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; Pϭ0.02). At the end of follow-up (29.3Ϯ27.1 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; Pϭ0.03), shorter right index of myocardial performance ratio (0.91; 95% confidence interval, 0.87 to 0.96; Pϭ0.005), and preoperative New York Heart Association IV class (1.71; 95% confidence interval, 1.3 to 2.2; PϽ0.0001). 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

Surgical outcomes of severe tricuspid regurgitation: predictors of adverse clinical outcomes

“…Surgical results of TV replacement or isolated TV surgery have been documented as poor, with 10%–30% early mortality in most reports 1–3 9 13. However, several reports suggest that TV replacement itself is not a risk factor for poor outcome, but the patient's conditions that led to TV replacement may be the culprit for poor survival.…”

Prognostic Value of Preoperative Right Ventricular Geometry and Tricuspid Valve Tethering Area in Patients Undergoing Tricuspid Annuloplasty

“…Current recommendations suggest that TV surgery be considered for severe isolated TR only when symptoms of heart failure are present. 3,4 However, symptom-based surgery carries a dismal outcome, 9,28 and surgery based on RV geometry and TV dimension, before the development of symptoms, can improve surgical outcome in this group of patients. Because of the small sample size, determining the potential independent association between individual RV geometry, particularly RV midcavity and basal diameters and TV tethering area, with adverse events was not feasible.…”

Tricuspid annular plane systolic excursion (TAPSE) can predict the outcome of isolated tricuspid valve surgery in patients with previous cardiac surgery?

“…Analysis of its size and function is often limited to subjective visual analysis. More sophisticated measures of RV function; i.e., the calculation of RV end systolic areas and the right index of myocardial performance (RIMP) ratios, have been shown to be valid predictors of mortality in TV disease (9,10). These procedures, however, require experienced personnel for image acquisition.…”