Concomitant Tricuspid Valve Operations Affect Outcomes After Mitral Operations: A Multiinstitutional, Statewide Analysis

• Published in: The Annals of thoracic surgery Vol. 94; no. 1; pp. 52 - 58
• Main Authors: LaPar, Damien J., MD, MS, Mulloy, Daniel P., MD, Stone, Matthew L., MD, Crosby, Ivan K., MD, Lau, Christine L., MD, Kron, Irving L., MD, Ailawadi, Gorav, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2012; Elsevier
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Female; Humans; Male; Medical sciences; Middle Aged; Mitral Valve - surgery; Pneumology; Postoperative Complications - epidemiology; Risk; Surgery; Treatment Outcome; Tricuspid Valve - surgery; 35; Mitral valve; Prognosis; Treatment; Analysis; Surgery; Anesthesia; Circulatory system; Operation; Cardiology; Tricuspid valve
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.03.020

Background Mitral valve (MV) disease is often accompanied by concomitant tricuspid valve (TV) disease. This study determined the influence of performing TV procedures in the setting of MV operations within a multiinstitutional patient population. Methods From 2001 to 2008, 5,495 MV operations were performed at 17 different statewide centers. Of these, 5,062 patients (age, 63.4 ± 13.0 years) underwent an MV operation and 433 (age, 64.0 ± 14.2 years) underwent combined MV and TV (MV+TV) operations. The influence of concomitant TV procedures on operative death and the composite incidence of major complications was assessed by univariate and multivariate analyses. Results Patients undergoing MV+TV were more commonly women (62.7% vs 45.5%, p < 0.001), had higher rates of heart failure (73.7% vs 50.9%, p < 0.001), and more frequently underwent reoperations (17.1% vs 7.4%, p < 0.001) compared with MV patients. Other patient characteristics, including preoperative endocarditis (8.5% vs 8.2%, p = 0.78), were similar between groups. MV replacement (63.5%) was more common than repair (36.5%, p < 0.001) in MV+TV operations, and MV+TV operations incurred longer median cardiopulmonary bypass times (181 vs 149 minutes, p < 0.001). Unadjusted operative mortality (6.0% vs 10.4%, p = 0.001) and postoperative complications were higher after MV+TV compared with MV. More important, risk adjustment showed performance of concomitant TV procedures was an independent predictor of operative death (odds ratio, 1.50; p = 0.03) and major complications (odds ratio, 1.39; p = 0.004). Conclusions A concomitant TV operation is a proxy for more advanced valve disease. Compared with MV operations alone, simultaneous MV+TV operations are associated with elevated morbidity and death, even after risk adjustment. This elevated risk should be considered during preoperative patient risk stratification.