The Risk and Outcomes of Reoperative Tricuspid Valve Replacement Surgery

Authors

  • Cheng Chen Department of Cardiothoracic Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China
  • Min Ge Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
  • Jiaxin Ye Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
  • Yongqing Cheng Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
  • Tao Chen Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
  • Lichong Lu Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
  • Zhigang Wang Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
  • Dongjin Wang Department of Cardiothoracic Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China

DOI:

https://doi.org/10.1532/hsf.2981

Keywords:

Tricuspid valve, reoperation, Replacement

Abstract

Objectives: Functional tricuspid regurgitation (TR) usually occurs with previous cardiovascular surgery, which causes right-side heart failure and affects patient prognosis. Thus, we aimed to assess the risk and outcomes of isolated tricuspid valve replacement (TVR) after cardiovascular surgery.

Methods: We reviewed our hospital medical records and found 107 patients, who had undergone TVR following cardiovascular surgery from June 2009 to November 2017. Follow up was performed by telephone calls, with a mean follow up of 51 months (one to 120 months). Previous surgical procedures of all patients were recorded, and we compared the differences in baseline and preoperative characteristics between the survival and non-survival groups by univariate analysis. Furthermore, logistic regression analysis was performed to identify the risk factors. The variables with a P value < .05 on univariate analysis were entered into a multivariate analysis using stepwise selection.

Results: TVR was performed in 107 patients, including 89 survivors and 18 non-survivors during the follow up. There were 38 male and 69 female patients, and the mean age was 53.55 years. Hospital mortality was 16.8% (18/107). The APACHE II (P < .001) and mechanical ventilation time (P = .001) were higher in the non-survival group. The values of B-type natriuretic peptide (BNP), total bilirubin (TB), and blood urea nitrogen (BUN) before and after the operation and some preoperative values were different between the two groups (P < .05). The logistic regression analysis showed that APACHE II score, mechanical ventilation time, preoperative albumin, and postoperative TB were risk factors for TVR after cardiovascular surgery.

Conclusions: Reoperation tricuspid valve replacement is associated with high operative mortality. High APACHE II scores, mechanical ventilation time and postoperative TB were associated with increased short-term mortality risk, while high preoperative albumin levels decreased the risk. Positive reoperation for tricuspid valve prosthesis dysfunction can obtain satisfactory therapeutic effects, and survivors could benefit from the surgery.

References

Abu Sham'a R, Buber J, Grupper A, et al. 2013. Effects of tricuspid valve regurgitation on clinical and echocardiographic outcome in patients with cardiac resynchronization therapy. Europace 15:266-72.

Baumgartner H, Falk V, Bax JJ, et al. 2017. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38:2739-91.

Bernal JM, Morales D, Revuelta C, et al. 2005. Reoperations after tricuspid valve repair. J Thorac Cardiovasc Surg 130:498-503.

Buzzatti N, Iaci G, Taramasso M, et al. 2014. Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-Thoracic Surgery 46:713-9; discussion 9.

Campelo-Parada F, Lairez O, Carrie D. 2017. Percutaneous Treatment of the Tricuspid Valve Disease: New Hope for the "Forgotten" Valve. Rev Esp Cardiol (Engl Ed) 70:856-66.

Chen J, Abudupataer M, Hu K, et al. 2018. Risk factors associated with perioperative morbidity and mortality following isolated tricuspid valve replacement. The Journal of Surgical Research 221:224-31.

Dahou A, Magne J, Clavel MA, et al. 2015. Tricuspid Regurgitation Is Associated With Increased Risk of Mortality in Patients With Low-Flow Low-Gradient Aortic Stenosis and Reduced Ejection Fraction: Results of the Multicenter TOPAS Study (True or Pseudo-Severe Aortic Stenosis). JACC Cardiovasc Interv 8:588-96.

Fang L, Li W, Zhang W, Gu W, Zhu D. 2018. Mid-term results and risks of isolated tricuspid valve reoperation following left-sided valve surgery. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-Thoracic Surgery 53:1034-9.

Fender EA, Zack CJ, Nishimura RA. 2018. Isolated tricuspid regurgitation: outcomes and therapeutic interventions. Heart 104:798-806.

Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, et al. 2018. Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery. Respir Care 63:550-7.

Garcia Fuster R, Vazquez A, Pelaez AG, et al. 2011. Factors for development of late significant tricuspid regurgitation after mitral valve replacement: the impact of subvalvular preservation. Eur J Cardiothorac Surg 39:866-74; discussion 74.

Guenther T, Noebauer C, Mazzitelli D, et al. 2008. Tricuspid valve surgery: a thirty-year assessment of early and late outcome. Eur J Cardiothorac Surg 34:402-9; discussion 9.

Hamandi M, Smith RL, Ryan WH, et al. 2019. Outcomes of Isolated Tricuspid Valve Surgery Have Improved in the Modern Era. Ann Thorac Surg 108:11-5.

Hwang HY, Kim KH, Kim KB, Ahn H. 2014. Propensity score matching analysis of mechanical versus bioprosthetic tricuspid valve replacements. Ann Thorac Surg 97:1294-9.

Ibanez J, Riera M, Amezaga R, et al. 2016. Long-Term Mortality After Pneumonia in Cardiac Surgery Patients: A Propensity-Matched Analysis. J Intensive Care Med 31:34-40.

Itzhaki Ben Zadok O, Sagie A, Vaturi M, et al. 2019. Long-Term Outcomes After Mitral Valve Replacement and Tricuspid Annuloplasty in Rheumatic Patients. Ann Thorac Surg 107:539-45.

Izumi C, Miyake M, Takahashi S, et al. 2011. Progression of isolated tricuspid regurgitation late after left-sided valve surgery. Clinical features and mechanisms. Circ J 75:2902-7.

Kilic A, Saha-Chaudhuri P, Rankin JS, Conte JV. 2013. Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of Thoracic Surgeons database. Ann Thorac Surg 96:1546-52; discussion 52.

Kingeter AJ, Raghunathan K, Munson SH, et al. 2018. Association between albumin administration and survival in cardiac surgery: a retrospective cohort study. Can J Anaesth 65:1218-27.

Mao B, Sun L, Zhang J, Zhou M, Zhang F. 2016. Perioperative factors associated with short- and long-term outcomes after tricuspid valve replacement. Interact Cardiovasc Thorac Surg 23:845-50.

Moutakiallah Y, Aithoussa M, Atmani N, et al. 2018. Reoperation for isolated rheumatic tricuspid regurgitation. J Cardiothorac Surg 13:104.

Nath J, Foster E, Heidenreich PA. 2004. Impact of tricuspid regurgitation on long-term survival. Journal of the American College of Cardiology 43:405-9.

Nimgaonkar A, Karnad DR, Sudarshan S, Ohno-Machado L, Kohane I. 2004. Prediction of mortality in an Indian intensive care unit. Comparison between APACHE II and artificial neural networks. Intensive Care Med 30:248-53.

Park CK, Park PW, Sung K, et al. 2009. Early and midterm outcomes for tricuspid valve surgery after left-sided valve surgery. The Annals of Thoracic Surgery 88:1216-23.

Pfannmuller B, Moz M, Misfeld M, et al. 2013. Isolated tricuspid valve surgery in patients with previous cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery 146:841-7.

Pichette M, Liszkowski M, Ducharme A. 2017. Preoperative Optimization of the Heart Failure Patient Undergoing Cardiac Surgery. Can J Cardiol 33:72-9.

Pirracchio R, Petersen ML, Carone M, et al. 2015. Mortality prediction in intensive care units with the Super ICU Learner Algorithm (SICULA): a population-based study. Lancet Respir Med 3:42-52.

Rodriguez-Capitan J, Becerra-Munoz VM, Perez-Villardon B, et al. 2018. Clinical outcomes after tricuspid surgery: The role of previous cardiac surgery. Herz.

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

Subbotina I, Girdauskas E, Bernhardt AM, et al. 2017. Comparison of Outcomes of Tricuspid Valve Surgery in Patients with Reduced and Normal Right Ventricular Function. Thorac Cardiovasc Surg 65:617-25.

Zhu X, Luo Y, Zhang E, et al. 2018. Ten-year experience of tricuspid valve replacement with the St. Jude medical valve. Sci Rep 8:16654

Published

2020-09-14

How to Cite

Chen, C., Ge, M., Ye, J., Cheng, Y., Chen, T., Lu, L., Wang, Z., & Wang, D. (2020). The Risk and Outcomes of Reoperative Tricuspid Valve Replacement Surgery. The Heart Surgery Forum, 23(5), E658-E664. https://doi.org/10.1532/hsf.2981

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