Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes. (25th September 2020)

• Record Type: Journal Article
• Authors: Dreyfus, Julien; Flagiello, Michele; Bazire, Baptiste; Eggenspieler, Florian; Viau, Florence; Riant, Elisabeth; Mbaki, Yannick; Bohbot, Yohann; Eyharts, Damien; Senage, Thomas; Dubrulle, Henri; Nicol, Martin; Doguet, Fabien; Nguyen, Virginia; Coisne, Augustin; Le Tourneau, Thierry; Lavie-Badie, Yoan; Tribouilloy, Christophe; Donal, Erwan; Tomasi, Jacques; Habib, Gilbert; Selton-Suty, Christine; Raffoul, Richard; Iung, Bernard; Obadia, Jean-François; Messika-Zeitoun, David
• Is Part Of: European heart journal. Volume 41:Number 45(2020)
• Page Start: 4304
• Page End: 4317
• Publication Date: 2020-09-25
• Subjects: Tricuspid regurgitation -- Surgery -- Outcome; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehaa643
• Languages: English
• ISSNs: 0195-668X

Abstract

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. Graphical Abstract: