Beating versus arrested heart isolated tricuspid valve surgery: An 11‐year experience in the current era

Abstract

Background and aim of the study Data about the beating heart (BH) technique for isolated tricuspid valve (TV) surgery compared to the arrested heart (AH) technique are sparse. We compared the outcomes of isolated TV surgery between BH and AH technique. Methods We performed an observational analysis of our database of isolated TV surgery. Patients were divided into two groups according to whether surgery was performed without (BH group) or with (AH group) aortic cross‐clamping and cardioplegic arrest. The primary endpoint was survival to hospital discharge. Risk factors for in‐hospital mortality were searched with multivariate analyses. We undertook further comparisons after propensity‐score matching. Results From January 2007 to December 2017, we performed 82 isolated TV surgery (BH group, n = 47, 57.3%; AH group, n = 35, 42.7%). The mean age was 59.1 years, 56.1% were female. BH group patients were older (61.8 vs. 55.4 years; p = .035), had greater impaired renal function (glomerular filtration rate, 61.1 vs. 74.6 ml/min; p = .012), were more frequently operated for secondary TR (61.7 vs. 31.4%; p = .008), underwent more frequently a reoperation (53.2 vs. 28.6%; p = .042) and exhibited a higher surgical risk (EuroSCORE II, 3.92 vs. 2.50%; p = .013). In‐hospital mortality was not different between both groups, either considering unmatched (BH = 10.6 vs. AH = 5.7%; OR = 1.96, 95% confidence interval [CI] = 0.36–10.77) or matched populations (BH = 10.6 vs. AH = 6.4%; OR = 1.89, 95% CI = 0.36–9.97). Age was the only predictor of in‐hospital mortality. Conclusions The BH technique showed comparable outcomes to the AH technique for isolated TV surgery despite a higher risk profile.

Isolated tricuspid valve surgery: Beating or nonbeating surgery?

“…The existing literature has shown in‐hospital mortality of 2%–13% 7 . The results produced by Flagiello et al 6 were also within this range, with an overall in‐hospital mortality rate of 8.5%. This data reaffirms the use of the BH technique for isolated TV surgery being safe and reliable.…”

“…Follow up data is crucial for understanding differences in long‐term outcomes between the two surgical techniques. Flagiello et al 6 only managed to collect follow up data for 60% of the patients. 8.5% of patients died, however follow up data for the remaining 30% of patients was not obtained.…”

“…The study by Flagiello et al 6 compared the outcomes of both the BH and AH technique for isolated TV surgery at a single center, over an eleven‐year period. A database of isolated TV surgeries formed the basis on this observational analysis, in which patients were divided into two groups according to the surgical technique used: BH ( n = 47) or AH ( n = 35).…”

“…This data reaffirms the use of the BH technique for isolated TV surgery being safe and reliable. However, it is important to consider when is best to apply this technique, as several studies indicate that candidates for the BH technique tend to be of an older age, with impaired renal function and at higher surgical risk with more reoperation rates 4–6 . Flagiello et al 6 suggests the BH technique could offer a “technical solution” for more complex patients undergoing isolated TV surgery.…”

“…However, it is important to consider when is best to apply this technique, as several studies indicate that candidates for the BH technique tend to be of an older age, with impaired renal function and at higher surgical risk with more reoperation rates 4–6 . Flagiello et al 6 suggests the BH technique could offer a “technical solution” for more complex patients undergoing isolated TV surgery. However, the BH technique is arguably technically more challenging due to an obscured exposure of the surgical field when the heart is beating and a large volume of blood returns.…”