Comparison of Outcomes of Tricuspid Valve Surgery in Patients with Reduced and Normal Right Ventricular Function

 

 Buy Article Permissions and Reprints All articles of this category

Abstract

Background To study the effect of tricuspid valve repair/replacement on outcomes of patients with reduced systolic right ventricular function.

Methods Between January 2012 and July 2016, 191 patients with isolated tricuspid valve regurgitation and/or in combination with other valve diseases were enrolled into this retrospective study. We compared early postoperative outcomes (i.e., 30 days after surgery) between patients' cohort with a preoperative reduced (i.e., at least moderately) versus normal (or mildly reduced) right ventricular function as defined by means of preoperative echocardiography.

Results A total of 82 (43%) patients had preoperatively reduced right ventricle function with tricuspid annular plane systolic excursion (TAPSE) of 13.3 ± 3.3 versus 20.2 ± 4.9 mm (p < 0.001). Ring annuloplasty was the most common surgical technique (i.e., 91% in both groups). Time of procedure (317 ± 123 vs. 262 ± 88 minutes, p < 0.01) and time on cardiopulmonary bypass (163 ± 77 vs. 143 ± 57 minutes, p = 0.036) were significantly longer in patients with impaired right ventricular function. Postoperative lactate (3.5 ± 3 vs. 2 ± 1 mmol/L, p = 0.001) and dose of catecholamines (epinephrine, 0.07 ± 0.15 vs. 0.013 ± 0.02 µg/kg/min, p = 0.001; norepinephrine, 0.18 ± 0.23 vs. 0.07 ± 0.09 µg/kg/min, p = 0.007) were also higher in this group. Postoperative rate of low cardiac output syndrome (10 vs. 27%, p = 0.005) and early mortality (n = 2 vs. n = 9, p = 0.018) were significantly increased in patients with reduced right ventricular function. Previous cardiac operation (p = 0.045), preoperative higher number of acute decompensations of heart failure (p < 0.001), reduced right ventricular function (p = 0.018), postoperative low cardiac output syndrome (p < 0.001), and renal replacement therapy (p < 0.001) were identified as risk factors for early mortality. Echocardiography at discharge revealed tricuspid valve regurgitation grade of 0.9 ± 0.7 versus 0.7 ± 0.6 (p = 0.052) and TAPSE of 12 ± 3 versus 15 ± 5 mm (p = 0.026) in patients with reduced right ventricular function. The New York Heart Association (NYHA) class improved to 1.7 ± 0.7 versus 1.3 ± 1 (p < 0.001) in this group of patients.

Conclusion Tricuspid valve repair/replacement effectively eliminated severe tricuspid regurgitation and improved clinical signs of heart failure. Although mortality and morbidity were increased in the group with reduced right ventricular function, even these patients benefitted from improved functional status and right ventricular systolic function early postoperatively.

Note

Part of the data has been presented at the 46th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery in Leipzig (http://www.professionalabstracts.com/dgthg2017/iplanner/#/grid).

• References

• 1 Vahanian A, Alfieri O, Andreotti F. , et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2012; 33 (19) 2451-2496
  CrossrefPubMedGoogle Scholar
• 2 Braunwald NS, Ross Jr J, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation 1967; 35 (4, Suppl) 163-169
  PubMedGoogle Scholar
• 3 Porter A, Shapira Y, Wurzel M. , et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis 1999; 8 (01) 57-62
  PubMedGoogle Scholar
• 4 Dreyfus GD, Corbi PJ, Chan KM, Bahrami T. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair?. Ann Thorac Surg 2005; 79 (01) 127-132
  CrossrefPubMedGoogle Scholar
• 5 King RM, Schaff HV, Danielson GK. , et al. Surgery for tricuspid regurgitation late after mitral valve replacement. Circulation 1984; 70 (3, Pt 2): 1193-1197
  PubMedGoogle Scholar
• 6 Fukuda S, Gillinov AM, Song JM. , et al. Echocardiographic insights into atrial and ventricular mechanisms of functional tricuspid regurgitation. Am Heart J 2006; 152 (06) 1208-1214
  CrossrefPubMedGoogle Scholar
• 7 McGrath LB, Gonzalez-Lavin L, Bailey BM, Grunkemeier GL, Fernandez J, Laub GW. Tricuspid valve operations in 530 patients. Twenty-five-year assessment of early and late phase events. J Thorac Cardiovasc Surg 1990; 99 (01) 124-133
  CrossrefPubMedGoogle Scholar
• 8 Scully HE, Armstrong CS. Tricuspid valve replacement. Fifteen years of experience with mechanical prostheses and bioprostheses. J Thorac Cardiovasc Surg 1995; 109 (06) 1035-1041
  CrossrefPubMedGoogle Scholar
• 9 Ratnatunga CP, Edwards MB, Dore CJ, Taylor KM. Tricuspid valve replacement: UK heart valve registry mid-term results comparing mechanical and biological prostheses. Ann Thorac Surg 1998; 66 (06) 1940-1947
  CrossrefPubMedGoogle Scholar
• 10 McCarthy PM, Bhudia SK, Rajeswaran J. , et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg 2004; 127 (03) 674-685
  CrossrefPubMedGoogle Scholar
• 11 Tang GHL, David TE, Singh SK, Maganti MD, Armstrong S, Borger MA. Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes. Circulation 2006; 114 (1, Suppl) 1577-1581
  PubMedGoogle Scholar
• 12 Baughman KL, Kallman CH, Yurchak PM, Daggett WM, Buckley MJ. Predictors of survival after tricuspid valve surgery. Am J Cardiol 1984; 54 (01) 137-141
  CrossrefPubMedGoogle Scholar