Long-Term Follow-Up Of Isolated Tricuspid Valve Surgery

• Published in: Revista portuguesa de cirurgia cardio-torácica e vascular Vol. 27; no. 4; p. 257
• Main Authors: Oliveira, Paulo Veiga, Madeira, Márcio, Ranchordás, Sara, Sousa-Uva, Miguel
• Format: Journal Article
• Language: English
• Published: Portugal 01.10.2020
• Subjects: Adult; Cardiac Surgical Procedures; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Reoperation; Retrospective Studies; Treatment Outcome; Tricuspid Valve - surgery
• ISSN: 0873-7215

Introduction Most patients with significant tricuspid valve disease (TVD) have concomitant left-sided heart disease and heart failure. However, a growing population of adult patients are developing isolated severe TVD. The role of surgery in these patients is unclear, with literature reporting high rates of early and late events. Objectives Analyze early and late outcomes of isolated tricuspid valve surgery (ITVS) and identify predictors of poor prognosis. Materials and Methods Single center retrospective study of all patients who underwent ITVS between 2007 and 2020. Exclusion criteria: congenital heart diseases and concomitant non-tricuspid valve surgery. Fifty-three patients were submitted to ITVS, with a mean age of 57 years old and 45.3% female gender. Clinical records and National Data Base were used for long term follow-up. The mean follow-up were 4.7 years (SD: 4,04) for 100% of the patients. Primary end-points: early - MACCE defined as a composite endpoint including at least one of the following in- -hospital variables: in-hospital mortality, cardiac arrest, stroke, acute renal lesion, acute hepatic lesion, bleeding requiring surgery; late -all cause mortality. Logistic regression and Cox proportional analysis were used with all clinical relevant variables selected a priori (not a stepwise method). Long-term survival was estimated using the Kaplan-Meier method. Results Thirty patients (56.6%) were diagnosed with functional disease, 28.3% with infective endocarditis, 7.5% rheumatic disease and 7.5% with prosthesis/repair dysfunction. The Majority of patients (67.9%) presented with tricuspid regurgitation. Twenty-three (43%) patients had previous cardiac surgery. Twenty-nine patients (54.7%) underwent tricuspid repair and 45.3% valve replacement (87,5% bioprosthetic vs 12.5% mechanical). The median in hospital stay was 23 days. MACCE occurred in 22.6% of the patients, with 11.3% of in-hospital mortality. Hypertension (OR 9.5; CI95%:1.03- 87.44; p=0,047) and left ventricle ejection fraction <50% (OR 5.8; CI95%:1.12-29.59; p=0,036) were independent predictors of in-hospital MACCE. Overall, the actuarial survival at 1, 5 and 10 years was 70%, 61% and 45%, respectively. Diabetes mellitus (HR 3.3; CI95%:1.31-8.52; p=0,012) was associated with increased all-cause long-term mortality. Conclusions As has been previously reported in literature, morbidity and mortality after isolated tricuspid surgery are high, with an increased rate of death at first year after surgery. Hypertension, cardiac dysfunction and diabetes mellitus are predictors of poor outcomes.