Outcomes of Isolated Tricuspid Valve Surgery
DOI:
https://doi.org/10.1532/hsf.3093Keywords:
Tricuspid regurgitation, Isolated tricuspid valve surgery, Valve repair, Valve replacementAbstract
Background: Isolated tricuspid valve surgery is a rarely performed procedure and traditionally is associated with a bad prognosis, although its clinical outcomes still are little known. The aim of this study was to assess the short- and long-term clinical outcomes obtained at our center after isolated tricuspid valve surgery as treatment for severe tricuspid regurgitation.
Methods: This retrospective study included 71 consecutive patients with severe tricuspid regurgitation who underwent isolated tricuspid valve surgery between December 1996 and December 2017. Perioperative and long-term mortality, tricuspid valve reoperation, and functional class were analyzed after follow up.
Results: Regarding surgery, 7% of patients received a De Vega annuloplasty, 14.1% an annuloplasty ring, 11.3% a mechanical prosthesis, and 67.6% a biological prosthesis. Perioperative mortality was 12.7% and no variable was shown to be predictive of this event. After a median follow up of 45.5 months, long-term mortality was 36.6%, and the multivariate analysis identified atrial fibrillation as the only predictor (Hazard Ratio 3.014, 95% confidence interval 1.06-8.566;
P = 0.038). At the end of follow up, 63.6% of survivors had functional class I.
Conclusions: Isolated tricuspid valve surgery was infrequent in our center. Perioperative mortality was high, as was long-term mortality. However, a high percentage of survivors were barely symptomatic after follow up.
References
Alqahtani F, Berzingi CO, Aljohani S, Hijazi M, Al-Hallak A, Alkhouli M. 2017. Contemporary Trends in the Use and Outcomes of Surgical Treatment of Tricuspid Regurgitation. J Am Heart Assoc 6. pii: e007597.
Baumgartner H, Falk V, Bax JJ, et al. 2017. ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38:2739–91.
Becerra-Muñoz VM, Rodríguez-Capitán J, Sánchez-Espín G, Such-Martínez M, Gómez-Doblas JJ, de Teresa-Galván E. 2019. Outcomes After Surgical Treatment of Severe Tricuspid Regurgitation in a Contemporary Series. Rev Esp Cardiol (Engl Ed) 72:178-80.
Chen J, Hu K, Ma W, et al. 2020. Isolated reoperation for tricuspid regurgitation after left-sided valve surgery: technique evolution. Eur J Cardiothorac Surg 5:142-150.
Chen Z, Ke Y, Xie X, et al. 2019. Beating-Heart Totally Endoscopic Tricuspid Valvuloplasty in Reoperative Cardiac Surgery. Ann Thorac Surg 107:e79-e82.
De Meester P, Van De Bruaene A, Voigt J-U, Herijgers P, Budts W. 2014. Outcome and determinants of prognosis in patients undergoing isolated tricuspid valve surgery: Retrospective single center analysis. Int J Cardiol 175:333-9.
Ejiofor JI, Neely RC, Yammine M, et al. 2017. Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement. Ann Cardiothorac Surg 6:214-22.
Fender EA, Zack CJ, Nishimura RA. 2018. Isolated tricuspid regurgitation: outcomes and therapeutic interventions. Heart 104:798-806.
Gammie JS, Sheng S, Griffith BP, et al. 2009. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 87:1431–37.
Guenther T, Noebauer C, Mazzitelli D, Busch R, Tassani-Prell P, Lange R. 2008. Tricuspid valve surgery: a thirty-year assessment of early and late outcome. Eur J Cardiothorac Surg 34:402-9.
Kaneko T, Vassileva CM, Englum B, et al. 2015. Contemporary outcomes of repeat aortic valve replacement: a benchmark for transcatheter valve-in-valve procedures. Ann Thorac Surg 100:1298–1304.
Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. 2013. Clinical and echocardiographic outcomes after surgery for severe isolated tricuspid regurgitation. J Thorac Cardiovasc Surg 146:278–84.
Kim YJ, Kwon DA, Kim HK, et al. 2009. Determinants of surgical outcome in patients with isolated tricuspid regurgitation. Circulation 120:1672–78.
Kundi H, Popma JJ, Cohen DJ, et al. 2019. Prevalence and Outcomes of Isolated Tricuspid Valve Surgery Among Medicare. Am J Cardiol 123:132-8.
Kuwaki K, Morishita K, Tsukamoto M, Abe T. 2001. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg 20:577-82.
Lang RM, Bierig M, Devereux BB, et al. Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. 2005. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of ≥the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–63.
Lee JW, Song JM, Park JP, Lee JW, Kang DH, Song JK. 2010. Long-Term Prognosis of Isolated Significant Tricuspid Regurgitation. Circ J;74:375-80.
Liu P, Qiao WH, Sun FQ, et al. 2016. Should a Mechanical or Biological Prosthesis Be Used for a Tricuspid Valve Replacement? A Meta-Analysis. J Card Surg 31:294-302.
Liu S, Chen JM, Wang WS, et al. 2019. Short-term outcomes of minimally invasive reoperation for tricuspid regurgitation after left-sided valve surgery. Zhonghua Wai Ke Za Zhi. 57:898-901.
Lu S, Song K, Yao W, et al. 2020. Simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery. Version 2. J Cardiothorac Surg;15:146.
Mangoni AA, DiSalvo TG, Vlahakes GJ, Polanczyk CA, Fifer MA. 2001. Outcome following isolated tricuspid valve replacement. Eur J Cardiothorac Surg 19:68–73.
Nath J, Foster E, Heidenreich PA. 2004. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 43:405-9.
Pfannmüller B, Misfeld M, Borger MA, et al. 2012. Isolated reoperative minimally invasive tricuspid valve operations. Ann Thorac Surg 94:2005-10.
Rodríguez-Capitán J, Gómez-Doblas JJ, Fernández-López L, et al. Short- and long-term outcomes of surgery for severe tricuspid regurgitation. 2013. Rev Esp Cardiol (Engl Ed) 66:629-35.
Shah PM, Raney AA. 2008. Tricuspid Valve Disease. Curr Probl in Cardiol 3:47-84.
Taramasso M, Alessandrini H, Latib A, et al. 2019. Outcomes After Current Transcatheter Tricuspid Valve Intervention: Mid-Term Results From the International TriValve Registry. JACC Cardiovasc Interv 12:155-65.
Topilsky Y, Khanna AD, Oh JK, et al. 2011. Preoperative factors associated with adverse outcome after tricuspid valve replacement. Circulation 123:1929–39.
Topilsky Y, Maltais S, Medina Inojosa J, et al. 2019. Burden of Tricuspid Regurgitation in Patients Diagnosed in the Community Setting. JACC Cardiovasc Imaging 12:433-42.
Zack CJ, Fender EA, Chandrashekar P, et al. 2017. National Trends and Outcomes in Isolated Tricuspid Valve Surgery. J Am Coll Cardiol 70:2953-60.
Zoghbi WA, Enriquez-Sarano M, Foster E, et al. 2003. American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802.
