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Beating Versus Arrested Heart Isolated Tricuspid Valve Surgery: Long-term Outcomes.

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Isolated tricuspid valve surgery using the beating heart (BH) technique shows a trend toward better long-term survival and fewer reoperations compared to the arrested heart (AH) method. BH valve repair offers the best outcomes.

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Valve Surgery
  • Thoracic Surgery

Background:

  • Isolated tricuspid valve (TV) surgery is a high-risk procedure with historically poor outcomes.
  • Surgical options include arrested heart (AH) and beating heart (BH) techniques.

Purpose of the Study:

  • To compare the outcomes of isolated tricuspid surgery using AH versus BH techniques.
  • To evaluate the safety and efficacy of different surgical approaches for isolated TV procedures.

Main Methods:

  • A multicenter international retrospective study (Surgical-Tricuspid Study) included 406 adult patients undergoing isolated TV procedures.
  • Propensity score-matched analysis compared 129 pairs of patients from AH (n=253) and BH (n=153) groups.

Main Results:

  • 30-day mortality rates were similar (6.2% AH vs. 5.0% BH).
  • The AH group had higher rates of acute renal failure (10% vs. 3%) and a trend towards more strokes (1.6% vs. 0%).
  • BH surgery demonstrated better 6-year outcomes, including improved survival and freedom from cardiac death, with significantly lower rates of cardiac death and reoperation (86% vs. 60% for BH repair vs. AH replacement).

Conclusions:

  • Beating heart (BH) strategy for isolated tricuspid valve surgery is a safe and effective alternative to the arrested heart (AH) technique.
  • BH surgery, particularly valve repair, is associated with improved long-term survival and reduced reoperation rates.
  • These findings suggest BH techniques may offer superior outcomes for isolated tricuspid valve interventions.