Performing Concomitant Tricuspid Valve Repair at the Time of Mitral Valve Operations Is Not Associated With Increased Operative Mortality

• Published in: The Annals of thoracic surgery Vol. 103; no. 2; pp. 587 - 593
• Main Authors: Badhwar, Vinay, MD, Rankin, J. Scott, MD, He, Max, MS, Jacobs, Jeffrey P., MD, Furnary, Anthony P., MD, Fazzalari, Frank L., MD, O’Brien, Sean, PhD, Gammie, James S., MD, Shahian, David M., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.02.2017
• Subjects: Aged; Cardiothoracic Surgery; Echocardiography; Female; Heart Valve Prosthesis Implantation - methods; Humans; Male; Middle Aged; Mitral Valve - surgery; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - surgery; Retrospective Studies; Severity of Illness Index; Surgery; Survival Rate - trends; Treatment Outcome; Tricuspid Valve - diagnostic imaging; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency - complications; Tricuspid Valve Insufficiency - surgery; United States - epidemiology; OR; AF; CI; odds ratio; tricuspid valve repair; PPM; The Society of Thoracic Surgeons; ACSD; MVRR; permanent pacemaker; coronary artery bypass graft surgery; tricuspid regurgitation; TVr; atrial fibrillation; STS; Adult Cardiac Surgery Database; confidence interval; ACC/AHA; CABG; mitral valve repair or replacement; TR; American College of Cardiology/American Heart Association
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2016.06.004

Background The performance of concomitant tricuspid valve repair (TVr) at the time of mitral valve repair or replacement (MVRR) has previously been associated with elevated short-term risk. Outcomes were assessed at incremental grades of tricuspid regurgitation (TR) to quantify the contemporary risk of concomitant TVr. Methods Between July 2011 and June 2014, 88,473 patients undergoing MVRR were examined using The Society of Thoracic Surgeons database. Outcomes with or without TVr, after isolated MVRR (n = 62,118) and MVRR with coronary artery bypass graft surgery (CABG [n = 26,355]), were independently analyzed at three levels of TR: none-mild, moderate, and severe. Risk-adjusted morbidity and mortality associated with the performance of concomitant TVr were evaluated using multivariable logistic regression. Results The TR was graded as none-mild in 74.3% of patients (65,769 of 88,473), moderate in 17.2% (15,222 of 88,473), and severe in 8.5% (7,482 of 88,473). The rate of TVr by TR grade was 3.5% (2,308 of 65,769) for none-mild, 30.6% (4,661 of 15,222) for moderate, and 75.6% (5,654 of 7,482) for severe. Overall risk-adjusted occurrence of any morbidity associated with performance of TVr was increased in both groups (MVRR odds ratio [OR] 1.36, 95% confidence interval [CI]: 1.24 to 1.48; and MVRR plus CABG OR 1.33, 95% CI: 1.19 to 1.49). However, at all grades of TR, TVr was not associated with increased risk-adjusted mortality (MVRR OR 0.99, 95% CI: 0.84 to 1.17; and MVRR plus CABG OR 1.04, 95% CI: 0.85 to 1.27). Conclusions In contemporary patients, concomitant TVr is not associated with a risk-adjusted increase in mortality, regardless of TR severity. A more liberal approach to TVr at the time of MVRR may be justified when long-term benefits are thought to outweigh incremental short-term morbidity risk. Further investigation of longitudinal TVr outcomes is warranted.