Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes

Abstract

Aims The aim of this study was to identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) and more specifically the impact of tricuspid regurgitation (TR) mechanism and clinical presentation. Methods and results Among 5661 consecutive adult patients who underwent a tricuspid valve (TV) surgery at 12 French tertiary centres in 2007–2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease [47% in New York Heart Association (NYHA) III/IV, 57% with right-sided heart failure (HF) signs]. Tricuspid regurgitation was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31%, respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14% vs. 6%, P = 0.004), but presentation was more severe. Independent determinants of outcomes were NYHA Class III/IV [odd ratios (OR) = 2.7 (1.2–6.1), P = 0.01], moderate/severe right ventricular dysfunction [OR = 2.6 (1.2–5.8), P = 0.02], lower prothrombin time [OR = 0.98 (0.96–0.99), P = 0.008], and with borderline statistical significance, right-sided HF signs [OR = 2.4 (0.9–6.5), P = 0.06] while TR mechanism was not [OR = 0.7 (0.3–1.8), P = 0.88]. Conclusion Isolated TV surgery was associated with high mortality and morbidity, both in hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.

Cardiac Surgery 2020 Reviewed

“…A multicenter analysis from 12 French cardiac surgery departments identified 466 patients who received isolated tricuspid surgery. 63 They found 10% operative mortality and significant complications in one-third of the patients.…”

Transcatheter treatment by valve-in-valve and valve-in-ring implantation for prosthetic tricuspid valve dysfunction

“…Cardiac magnetic resonance (CMR) imaging might be a valuable complement for assessment of RV function particularly in patients where the imaging quality is limited. A recent analysis of patients undergoing isolated tricuspid valve surgery confirmed right heart failure signs and right ventricular dysfunction as significant independent predictors of all-cause mortality [ 2 ]; however, future studies need to identify which patients might benefit from TViR/TViV interventions and where these procedures might be futile.…”

“…Valve degeneration after tricuspid valve repair or replacement is frequent and can require tricuspid valve r‑intervention [ 1 ]; however, recent data illustrate that isolated tricuspid valve interventions inhere a significant procedural risk with in-hospital mortality rates ranging around 10% and major complications affecting up to one third of all patients [ 2 ]. Consequently, tricuspid resurgery is rarely performed and transcatheter tricuspid valve-in-ring (TViR) and valve-in-valve (TViV) repair have evolved as promising treatment options for the majority of patients who would otherwise remain untreated [ 3 , 4 ].…”

Prognostic impact of hepatorenal function in patients undergoing transcatheter tricuspid valve repair

“…Tricuspid regurgitation (TR) is a common valvular disease in patients with heart failure (HF) and is associated with impaired functional capacity and reduced long-term survival 1 – 3 . The treatment options for TR are still limited, and surgical repair for isolated TR is still controversial because of the high risk associated with the surgery 4 , 5 . TR patients often have multiple comorbidities that contribute to an elevated surgical risk.…”