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Outcomes of Isolated Tricuspid Valve Surgery
Gemma Sánchez-Espín1, Jorge Rodríguez-Capitán2, Juan José Otero Forero3
1Unidad de Gestión Clínica del Corazón, Hospital Virgen de la Victoria de Málaga, Málaga, Spain, Instituto Biosanitario Málaga (IBIMA), CIBERCV Málaga. Universidad de Málaga (UMA), Málaga, Spain. gemmase@hotmail.com.
The Heart Surgery Forum
|November 25, 2020
Summary
Isolated tricuspid valve surgery has high perioperative and long-term mortality, but survivors often achieve good functional class. Atrial fibrillation predicts long-term mortality in patients undergoing this rare procedure.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair and Replacement
- Adult Congenital Heart Disease
Background:
- Isolated tricuspid valve surgery is infrequently performed and carries a historically poor prognosis.
- Clinical outcomes of isolated tricuspid valve surgery remain poorly understood.
- Severe tricuspid regurgitation necessitates surgical intervention, yet data on isolated procedures are limited.
Purpose of the Study:
- To evaluate the short- and long-term clinical outcomes of isolated tricuspid valve surgery.
- To assess mortality, reoperation rates, and functional status after isolated tricuspid valve surgery for severe tricuspid regurgitation.
- To identify predictors of mortality following isolated tricuspid valve surgery.
Main Methods:
- Retrospective analysis of 71 consecutive patients undergoing isolated tricuspid valve surgery for severe tricuspid regurgitation (December 1996 - December 2017).
- Evaluation of perioperative and long-term mortality, need for tricuspid valve reoperation, and patient functional class (New York Heart Association).
- Multivariate analysis to identify predictors of long-term mortality.
Main Results:
- Surgical procedures included De Vega annuloplasty (7%), annuloplasty ring (14.1%), mechanical prosthesis (11.3%), and biological prosthesis (67.6%).
- Perioperative mortality was 12.7%, with no identified predictors.
- Long-term mortality was 36.6% after a median follow-up of 45.5 months; atrial fibrillation was the sole predictor (HR 3.014, P=0.038).
- At follow-up, 63.6% of survivors achieved functional class I.
Conclusions:
- Isolated tricuspid valve surgery is a rare procedure associated with significant perioperative and long-term mortality.
- Despite high mortality rates, a substantial proportion of survivors experience minimal symptoms and achieve good functional status.
- Atrial fibrillation is a significant risk factor for long-term mortality in patients undergoing isolated tricuspid valve surgery.
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