Residual Tricuspid Regurgitation following Tricuspid Valve Repair during Concomitant Valve Surgery Worsens Late Survival

Authors

  • Robert A. Sorabella Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
  • Erin Mamuyac Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
  • Halit Yerebakan Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
  • Marc Najjar Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
  • Vivian Choi Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
  • Hiroo Takayama Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
  • Yoshifumi Naka Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
  • Michael Argenziano Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
  • Craig R. Smith Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY
  • Isaac George Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, NY

DOI:

https://doi.org/10.1532/hsf.1469

Abstract

Background: Concomitant tricuspid valve repair (TVr) for functional tricuspid regurgitation (TR) at the time of left-sided valve surgery has become increasingly more common over the past decade. The impact of residual post-repair TR on late outcomes remains unclear.
Methods: All patients undergoing TVr during concomitant left-sided valve surgery at our institution from 2005-2012 were retrospectively reviewed. Patients were stratified into 2 groups according to the degree of post-cardiopulmonary bypass TR observed on intraoperative transesophageal echocardiography; 0-1+ TR (No TR, n = 246) and ≥2+ TR (Residual TR, n = 26). Primary outcomes of interest were 30-day survival, 4-year survival, and follow-up TR grade. A propensity-matched subgroup analysis was performed in addition to the overall cohort analysis.
Results: Mean age for all patients was 70.3 ± 13.0 years and 107 (39%) patients were male. There was no difference in 30-day survival between groups (92% No TR versus 96% Residual TR, P = .70). Kaplan-Meier analysis of overall 4-year survival showed a trend toward worsened survival in the Residual TR group (log rank P = .17) and propensity-matched subgroup analysis showed significantly worse 4-year survival for Residual TR (log rank P = .02). At mean echocardiographic follow up of 11.9 ± 22.5 months, TR grade was significantly worse in the Residual TR group compared to No TR (1.5 ± 0.8 Residual TR versus 0.9 ± 0.9 No TR,
P = .005), although TR severity was significantly improved from immediately post-bypass.
Conclusions: Patients left with residual TR following TVr during concomitant left-sided valve surgery have significantly decreased late survival compared to patients left with no post-repair TR.

References

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Published

2015-11-24

How to Cite

Sorabella, R. A., Mamuyac, E., Yerebakan, H., Najjar, M., Choi, V., Takayama, H., Naka, Y., Argenziano, M., Smith, C. R., & George, I. (2015). Residual Tricuspid Regurgitation following Tricuspid Valve Repair during Concomitant Valve Surgery Worsens Late Survival. The Heart Surgery Forum, 18(6), E226-E231. https://doi.org/10.1532/hsf.1469

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