https://doi.org/10.1007/s00392-024-02526-y
1Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 2Herz- und Diabeteszentrum NRW Klinik für Thorax- und Kardiovaskularchirurgie Bad Oeynhausen, Deutschland
Background: Tricuspid regurgitation (TR) is a common morbidity with increasing prevalence and is associated with increased mortality. Surgery of the tricuspid valve (TV) has been traditionally associated with high operative mortality. The aim of this study was to assess the temporal trends in TV surgery and determine factors associated with mortality in a high-volume single-center experience.
Methods and Results: A total of 1383 patients underwent surgery on the TV at our hospital between 2009 and 2019. Mean age was 70 ± 11 years, 56% were men, and the mean EuroSCORE II was 9.8 ±11%. Isolated TV surgery was performed in 308 patients (22.3%), of whom the majority (229 patients; 74.4%) underwent TV repair. In patients who received combined surgery, a great proportion (650 patients, 60.5%) underwent combined mitral and tricuspid valve surgery. TV surgery resulted in TR reduction to less than or equal to moderate in 95% of patients, with a very good result (TR ≤mild) in 91.5% of cases. In-hospital mortality occurred in 7.1% of patients. Over a median follow-up of 6.1 years, all-cause long-term mortality occurred in 39.3%. Not a single echocardiographic parameter was significantly associated with in-hospital mortality. In contrast, baseline patient characteristics were significantly predictive of both in-hospital and long-term mortality (tables 1 and 2). The presence of more than mild TR after surgery was an independent predictor of long-term overall mortality in patients who underwent isolated TV surgery (figure 1).
Conclusion: Predictors of in-hospital mortality after TV surgery were primarily of clinical nature. Echocardiographic parameters of RV function were not helpful in this regard. However, echocardiographic parameters of both LV and RV function were independent predictors of long-term mortality after surgery. Most importantly, more than residual TR after isolated TV surgery was significantly associated with worse long-term outcome, a finding that might be of relevance for current transcatheter therapies.
Figure1: Survival Analysis After Isolated TV Surgery Regarding Residual TR
Table 1: Cox regression analysis for predictors of in-hospital mortality after TV surgery
|
Predictor |
Univariate analysis |
Multivariate analysis | ||||
|
HR |
95% CI |
p-value |
HR |
95% CI |
p-value | |
|
EuroSCORE II |
1.033 |
[1.023-1.043] |
<0.001 |
1.015 |
[1.003-1.027] |
0.016 |
|
Post-op complications |
24.2 |
[11.2-52.4] |
<0.001 |
20.4 |
[9.4-44.4] |
<0.001 |
|
Arterial hypertension |
2.1 |
[1.2-3.8] |
0.012 |
2.2 |
[1.2-4.0] |
0.009 |
|
Elective Op |
0.28 |
[0.19-0.43] |
<0.001 |
0.58 |
[0.35-0.94] |
0.027 |
Table 2: Cox regression analysis for predictors of long-term mortality after TV surgery
|
Predictor |
Univariate analysis |
Multivariate analysis | ||||
|
HR |
95% CI |
p-value |
HR |
95% CI |
p-value | |
|
LVEF |
0.98 |
[0.97-0.99] |
<0.001 |
0.97 |
[0.96-0.99] |
0.007 |
|
TAPSE |
0.91 |
[0.88-0.95] |
<0.001 |
0.94 |
[0.88-1.0] |
0.050 |
|
Age |
1.02 |
[1.018-1.037] |
<0.001 |
1.04 |
[1.03-1.05] |
<0.001 |
|
Postoperative complications |
2.82 |
[2.37-3.34] |
<0.001 |
2.57 |
[2.1-3.1] |
<0.001 |
|
TV replacement (vs repair) |
1.70 |
[1.32-2.20] |
<0.001 |
1.87 |
[1.5-2.5] |
<0.001 |
|
Creatinine |
1.20 |
[1.13-1.27] |
<0.001 |
1.15 |
[1.04-1.26] |
0.004 |
|
Hemoglobin |
0.79 |
[0.76-0.84] |
<0.001 |
0.85 |
[0.81-0.90] |
<0.001 |
HR: hazard ratio, CI: confidence interval, LVEF: left ventricular ejection fraction, TAPSE: tricuspid annular plane systolic excursion, TV: tricuspid valve,
HR: hazard ratio, CI: confidence interval, LVEF: left ventricular ejection fraction, TAPSE: tricuspid annular plane systolic excursion, TV: tricuspid valve