Tricuspid Valve Disease: Surgical Outcome

Veen, Kevin M; Etnel, Jonathan R.G.; Takkenberg, Johanna J.M.

doi:10.1007/978-3-319-58229-0_16

Cited by 3 publications

(1 citation statement)

References 149 publications

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“…Interestingly, the relatively high reported rates of thrombosis of mechanical heart valves in the tricuspid position were not observed in this population. 15 Since the patient outcome depicts very much the standard pros and cons of biological versus mechanical prostheses, valve choice could be an item in the multidisciplinary team, taking into account expected lifespan, further carcinoid treatment and patient preferences using shared decision-making. Furthermore, valve choice can also be influenced by the prospect of transcatheter valvein-valve replacement of dysfunctional biological prostheses, which is already performed in dysfunctional prostheses in the pulmonary valve position.…”

Section: Commentmentioning

confidence: 99%

Outcomes after Tricuspid Valve Replacement for Carcinoid Heart Disease: A Multicenter Study

et al. 2020

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Background: This study evaluates clinical and echocardiographic outcomes in patients who underwent tricuspid valve replacement (TVR) for carcinoid heart disease (CaHD) stratified to prosthesis type (biological vs mechanical).Methods: All patients undergoing TVR for CaHD between 1991 and 2017 were analyzed retrospectively in four tertiary centers. Cox-proportional hazard models were used to analyze survival data and mixed-models for repeated measurements of echo and laboratory data.Results: In total, 49 patients (median age: 59 [51-66], 45% male) underwent biological (n = 20, 41%) or mechanical (n = 29, 59%) TVR. Three (6%) patients died in-hospital and 3-year actuarial survival was 73.3 ± 8.7% (biological) and 56.1 ± 10.0% (mechanical) (P = 0.69). During a median follow-up of 17 months, two patients with a biological prosthesis required reoperation for structural valve deterioration, while one patient with mechanical prostheses had a reoperation due to valve thrombosis. No significant differences in bleeding, thrombosis, thromboembolism and heart failure admissions were noted between prosthesis types. Postoperative valve regurgitation increased more in patients with a biological prosthesis (p = 0.022). Maximum tricuspid inflow gradient was higher in patients with biological prostheses (p = 0.02); however, course over time was comparable between prosthesis types (p = 0.136). Conclusion:Tricuspid valve surgery for CaHD can be performed with acceptable hospital mortality risk. This data shows no apparent benefit of biological valves over mechanical prosthesis or vice versa. Valve choice should be made in a multi-disciplinary team taking into account expected lifespan, planned treatment for the carcinoid syndrome and neuroendocrine tumor and patient preferences.

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Section: Commentmentioning

confidence: 99%

Outcomes after Tricuspid Valve Replacement for Carcinoid Heart Disease: A Multicenter Study

et al. 2020

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Clinical impact and ‘natural’ course of uncorrected tricuspid regurgitation after implantation of a left ventricular assist device: an analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS)

Veen

Mokhles

Soliman

et al. 2020

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Data on the impact and course of uncorrected tricuspid regurgitation (TR) during left ventricular assist device (LVAD) implantation are scarce and inconsistent. This study explores the clinical impact and natural course of uncorrected TR in patients after LVAD implantation. METHODS The European Registry for Patients with Mechanical Circulatory Support was used to identify adult patients with LVAD implants without concomitant tricuspid valve surgery. A mediation model was developed to assess the association of TR with 30-day mortality via other risk factors. Generalized mixed models were used to model the course of post-LVAD TR. Joint models were used to perform sensitivity analyses. RESULTS A total of 2496 procedures were included (median age: 56 years; men: 83%). TR was not directly associated with higher 30-day mortality, but mediation analyses suggested an indirect association via preoperative elevated right atrial pressure and creatinine (P = 0.035) and bilirubin (P = 0.027) levels. Post-LVAD TR was also associated with increased late mortality [hazard ratio 1.16 (1.06–1.3); P = 0.001]. On average, uncorrected TR diminished after LVAD implantation. The probability of having moderate-to-severe TR immediately after an implant in patients with none-to-mild TR pre-LVAD was 10%; in patients with moderate-to-severe TR pre-LVAD, it was 35% and continued to decrease in patients with moderate-to-severe TR pre-LVAD, regardless of pre-LVAD right ventricular failure or pulmonary hypertension. CONCLUSIONS Uncorrected TR pre-LVAD and post-LVAD is associated with increased early and late mortality. Nevertheless, on average, TR diminishes progressively without intervention after an LVAD implant. Therefore, these data suggest that patient selection for concomitant tricuspid valve surgery should not be based solely on TR grade.

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Male–female differences in characteristics and early outcomes of patients undergoing tricuspid valve surgery: a national cohort study in the Netherlands

Veen

Mokhles

Braun

et al. 2018

European Journal of Cardio-Thoracic Surgery

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Tricuspid Valve Disease: Surgical Outcome

Cited by 3 publications

References 149 publications

Outcomes after Tricuspid Valve Replacement for Carcinoid Heart Disease: A Multicenter Study

Outcomes after Tricuspid Valve Replacement for Carcinoid Heart Disease: A Multicenter Study

Clinical impact and ‘natural’ course of uncorrected tricuspid regurgitation after implantation of a left ventricular assist device: an analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS)

Male–female differences in characteristics and early outcomes of patients undergoing tricuspid valve surgery: a national cohort study in the Netherlands

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