Outcomes of Isolated Tricuspid Valve Surgery
Keywords:Tricuspid regurgitation, Isolated tricuspid valve surgery, Valve repair, Valve replacement
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.
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.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).