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Burden of Tricuspid Regurgitation in Patients Undergoing Coronary Artery Bypass Grafting

Nathan Haywood1, J Hunter Mehaffey1, W Zachary Chancellor1

  • 1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.

The Annals of Thoracic Surgery
|June 5, 2020
PubMed

Insights

Tricuspid regurgitation (TR) increases surgical risk and adverse outcomes in patients undergoing coronary artery bypass graft (CABG) surgery. This study suggests considering tricuspid intervention during CABG for patients with significant TR.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Outcomes

Background:

  • Tricuspid regurgitation (TR) is linked to adverse outcomes post cardiac surgery.
  • Current guidelines do not mandate TR correction during coronary artery bypass graft (CABG) surgery.

Purpose of the Study:

  • To evaluate the impact of tricuspid regurgitation severity on outcomes following CABG surgery.
  • To assess if TR severity influences major morbidity or mortality in CABG patients.

Main Methods:

  • Analysis of 28,027 patients undergoing CABG from 2011-2018 using The Society of Thoracic Surgeons (STS) database.
  • Stratification of patients by tricuspid regurgitation severity (mild, moderate, severe).
  • Comparison of primary outcomes including major morbidity and mortality using univariate analysis and risk adjustment.

Main Results:

  • 17% had mild, 3% moderate, and 0.29% severe TR.
  • Higher TR severity correlated with increased preoperative heart failure and STS predicted risk of mortality.
  • Increasing TR severity was associated with higher rates of postoperative renal failure, prolonged ventilation, and mortality (all P < .001).
  • Mild, moderate, and severe TR remained independently associated with increased morbidity and mortality after risk adjustment (all P < .05).

Conclusions:

  • Tricuspid regurgitation severity independently increases surgical risk in CABG patients, beyond STS risk calculator predictions.
  • These findings underscore the importance of TR in operative risk assessment.
  • Concurrent tricuspid intervention should be considered for patients with significant TR undergoing CABG.
Abstract

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