Preoperative Predictors of Postoperative Pulmonary Complication Following Isolated Tricuspid Valve Surgery
DOI:
https://doi.org/10.59958/hsf.7635Keywords:
tricuspid valve surgery, postoperative pulmonary complications, tricuspid regurgitationAbstract
Background: Postoperative pulmonary complications (PPC) are the most frequently observed complications following cardiac surgery, leading to extended hospital stays and significant medical and economic burdens. Although surgical interventions for tricuspid valve disease are increasingly common, few risk factors for PPC in the context of tricuspid valve surgery have been identified. Uncovering these factors would have valuable clinical implications in terms of prognosis. Methods: We conducted a single-center retrospective study to evaluate preoperative factors associated with susceptibility to PPC in patients undergoing tricuspid valve surgery between 2018 to 2023. Independent predictors of PPC were identified using regression analysis. Results: Of the 147 patients included in the study, 29.9% (44 cases) experienced PPC. No statistically significant differences were observed in surgical procedures between the groups. Regression analysis identified smoking status (odds ratio [OR]: 7.69, p = 0.01), severity grade of tricuspid regurgitation (TR) (OR: 26.56, p < 0.01), recent respiratory infection (OR: 78.52, p < 0.01), and pulmonary hypertension (OR: 13.60, p < 0.01) as independent risk factors for PPC following tricuspid valve surgery. Conversely, the 6-minute walk distance (6MWD) (OR: 0.99, p = 0.01) and tricuspid annular plane systolic excursion (TAPSE) (OR: 0.61, p < 0.01) were identified as independent protective factors. Conclusion: The incidence of PPC following tricuspid valve surgery was determined to be 29.9%. The identified predictors—smoking status, severity of tricuspid regurgitation, recent respiratory infections, pulmonary hypertension, as well as protective factors like 6MWD and TAPSE—can offer valuable insights for optimizing the preoperative physiological conditions in patients undergoing tricuspid valve surgery.
References
Qi X, Xu H, Liu Q. Analysis of diagnosis and treatment status of hospitalized patients with degenerative heart valve disease in China. Chinese Circulation Journal. 2019; 34: 771–776.
Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. Journal of the American College of Cardiology. 2004; 43: 405–409.
Patel KP, Baumbach A. Timing treatment for tricuspid regurgitation. European Heart Journal. 2024; 45: 598–600.
Xu H, Liu Q, Cao K, Ye Y, Zhang B, Li Z, et al. Distribution, Characteristics, and Management of Older Patients With Valvular Heart Disease in China: China-DVD Study. JACC. Asia. 2022; 2: 354–365.
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal. 2022; 43: 561–632.
Varma PK, Srimurugan B, Jose RL, Krishna N, Valooran GJ, Jayant A. Perioperative right ventricular function and dysfunction in adult cardiac surgery-focused review (part 2-management of right ventricular failure). Indian Journal of Thoracic and Cardiovascular Surgery. 2022; 38: 157–166.
Smilowitz NR, Berger JS. Perioperative Cardiovascular Risk Assessment and Management for Noncardiac Surgery: A Review. JAMA. 2020; 324: 279–290.
Ellenberger C, Schorer R, Bedat B, Hagerman A, Triponez F, Karenovics W, et al. How can we minimize the risks by optimizing patient's condition shortly before thoracic surgery? Saudi Journal of Anaesthesia. 2021; 15: 264–271.
Mathis MR, Duggal NM, Likosky DS, Haft JW, Douville NJ, Vaughn MT, et al. Intraoperative Mechanical Ventilation and Postoperative Pulmonary Complications after Cardiac Surgery. Anesthesiology. 2019; 131: 1046–1062.
Lusquinhos J, Tavares M, Abelha F. Postoperative Pulmonary Complications and Perioperative Strategies: A Systematic Review. Cureus. 2023; 15: e38786.
Thompson DA, Makary MA, Dorman T, Pronovost PJ. Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Annals of Surgery. 2006; 243: 547–552.
Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010; 113: 1338–1350.
Hadaya J, Verma A, Marzban M, Sanaiha Y, Shemin RJ, Benharash P. Impact of Pulmonary Complications on Outcomes and Resource Use After Elective Cardiac Surgery. Annals of Surgery. 2023; 278: e661–e666.
Tuna, M.E., Akgün, M. Preoperative pulmonary evaluation to prevent postoperative pulmonary complications. Anesthesiology and Perioperative Science. 2023; 1: 34.
Hahn RT, Zamorano JL. The need for a new tricuspid regurgitation grading scheme. European Heart Journal. Cardiovascular Imaging. 2017; 18: 1342–1343.
Zhang J, Hu X, Shan G. Spirometry reference values for population aged 7-80 years in China. Respirology. 2017; 22: 1630–1636.
Sclauser Pessoa IMB, Franco Parreira V, Fregonezi GAF, Sheel AW, Chung F, Reid WD. Reference values for maximal inspiratory pressure: a systematic review. Canadian Respiratory Journal. 2014; 21: 43–50.
Agarwala P, Salzman SH. Six-Minute Walk Test: Clinical Role, Technique, Coding, and Reimbursement. Chest. 2020; 157: 603–611.
Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respiratory Care. 2009; 54: 1348–1359.
Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet. 2015; 386: 1097–1108.
Pasquina P, Merlani P, Granier JM, Ricou B. Continuous positive airway pressure versus noninvasive pressure support ventilation to treat atelectasis after cardiac surgery. Anesthesia and Analgesia. 2004; 99: 1001–1008.
Reeve JC, Nicol K, Stiller K, McPherson KM, Birch P, Gordon IR, et al. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. European Journal of Cardio-Thoracic Surgery. 2010; 37: 1158–1166.
Boden I, Robertson IK, Neil A, Reeve J, Palmer AJ, Skinner EH, et al. Preoperative physiotherapy is cost-effective for preventing pulmonary complications after major abdominal surgery: a health economic analysis of a multicentre randomised trial. Journal of Physiotherapy. 2020; 66: 180–187.
Tanner TG, Colvin MO. Pulmonary Complications of Cardiac Surgery. Lung. 2020; 198: 889–896.
Elefterion B, Cirenei C, Kipnis E, Cailliau E, Bruandet A, Tavernier B, et al. Intraoperative Mechanical Power and Postoperative Pulmonary Complications in Noncardiothoracic Elective Surgery Patients: A 10-Year Retrospective Cohort Study. Anesthesiology. 2024; 140: 399–408.
Leong SL, Chen SH, Wei JCC. Total Intravenous Anesthesia and Postoperative Pulmonary Complications. JAMA Otolaryngology – Head & Neck Surgery. 2023; 149: 375–376.
Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Annals of Surgery. 2005; 242: 326–341; discussion 341–343.
Patel AS, Bergman A, Moore BW, Haglund U. The economic burden of complications occurring in major surgical procedures: a systematic review. Applied Health Economics and Health Policy. 2013; 11: 577–592.
Yang CK, Teng A, Lee DY, Rose K. Pulmonary complications after major abdominal surgery: National Surgical Quality Improvement Program analysis. The Journal of Surgical Research. 2015; 198: 441–449.
Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, et al. Acute respiratory distress syndrome. Nature Reviews. Disease Primers. 2019; 5: 18.
Wong J, Lam DP, Abrishami A, Chan MTV, Chung F. Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Canadian Journal of Anaesthesia. 2012; 59: 268–279.
Bingül ES, Şentürk NM, Kaynar AM. Prehabilitation: a narrative review focused on exercise therapy for the prevention of postoperative pulmonary complications following lung resection. Frontiers in Medicine. 2023; 10: 1196981.
Assouline B, Cools E, Schorer R, Kayser B, Elia N, Licker M. Preoperative Exercise Training to Prevent Postoperative Pulmonary Complications in Adults Undergoing Major Surgery. A Systematic Review and Meta-analysis with Trial Sequential Analysis. Annals of the American Thoracic Society. 2021; 18: 678–688.
Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Moonesinghe SR. Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ (Clinical Research Ed.). 2020; 368: m540.
Hahn RT, Lawlor MK, Davidson CJ, Badhwar V, Sannino A, Spitzer E, et al. Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints. European Heart Journal. 2023; 44: 4508–4532.
Rajagopal S, Ruetzler K, Ghadimi K, Horn EM, Kelava M, Kudelko KT, et al. Evaluation and Management of Pulmonary Hypertension in Noncardiac Surgery: A Scientific Statement From the American Heart Association. Circulation. 2023; 147: 1317–1343.
Luo Z, Qian H, Zhang X, Wang Y, Wang J, Yu P. Effectiveness and safety of inspiratory muscle training in patients with pulmonary hypertension: A systematic review and meta-analysis. Frontiers in Cardiovascular Medicine. 2022; 9: 999422.
Arora RC, Brown JK, Chatterjee S, Gan TJ, Singh G, Tong MZ, et al. Perioperative management of the vulnerable and failing right ventricle. Perioperative Medicine. 2024; 13: 40.
Punia S, Arora LL. Pulmonary Edema. Advanced Anesthesia Review (pp. 368). Oxford University Press: Oxford. 2023.
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2022; 79: e263–e421.
Scrutinio D, Guida P, Passantino A. Prognostic Value of 6-Minute Walk Test in Advanced Heart Failure With Reduced Ejection Fraction. The American Journal of Cardiology. 2023; 199: 37–43.
van Egmond MA, van der Schaaf M, Klinkenbijl JHG, Engelbert RHH, van Berge Henegouwen MI. Preoperative functional status is not associated with postoperative surgical complications in low risk patients undergoing esophagectomy. Diseases of the Esophagus. 2017; 30: 1–7.
Luo Z, Zhang X, Wang Y, Huang W, Chen M, Yang M, et al. An Accessible Pre-Rehabilitation Bundle for Patients Undergoing Elective Heart Valve Surgery with Limited Resources: The TIME Randomized Clinical Trial. Reviews in Cardiovascular Medicine. 2023; 24: 308.
Serpa Neto A, Hemmes SNT, Barbas CSV, Beiderlinden M, Fernandez-Bustamante A, Futier E, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: a systematic review and meta-analysis. The Lancet. Respiratory Medicine. 2014; 2: 1007–1015.
