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

Benedetto U, Melina G, Angeloni E, et al. 2012. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg 143:632-8.

Bertrand PB, Koppers G, Verbrugge FH, et al. 2014. Tricuspid annuloplasty concomitant with mitral valve surgery: Effects on right ventricular remodeling. J Thorac Cardiovasc Surg 147:1256-64.

Desai RR, Abello LMV, Klein AL, et al. 2013. Tricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure. J Thorac Cardiovasc Surg 146:1126-32.

Fukuda S, Gillinov AM, McCarthy PM, et al. 2006. Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation 114(sI):I-582-7.

Mahesh B, Wells F, Nashef S, et al. 2013. Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery. Eur J Cardiothorac Surg 43:2-8.

Matsunaga A, Duran CMG. 2005. Progression of Tricuspid Regurgitation After Repaired Functional Ischemic Mitral Regurgitation. Circulation 112(s1):I-453-7.

Nath J, Foster E, Heidenreich PA. 2004. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 43:405-9.

Nisimura RA, Otto CM, Bonow RO, et al. 2014. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol S0735-1097.

Rogers JH, Bolling SF. 2009. The tricuspid valve: current perspectives and evolving management of tricuspid regurgitation. Circulation 199:2718-25.

Shinn SH, Schaff HV. 2013. Evidence-based surgical management of acquired tricuspid valve disease. Nat Rev Cardiol 10:190-203.

Teman NR, Huffman LC, Krajacic M, et al. 2014. “Prophylactic” tricuspid repair for functional tricuspid regurgitation. Ann Thorac Surg 97:1520-4.

Vassileva CM, Shabosky J, Boley T, et al. 2012. Tricuspid valve surgery: The past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg 143:1043-9.

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

Issue

Section

Article