Surgical Outcomes of Severe Tricuspid Regurgitation: Predictors of Adverse Clinical Outcome

Study Questions:

What are predictors of clinical outcomes for patients undergoing tricuspid valve repair or replacement for severe tricuspid regurgitation (TR)?

Methods:

A retrospective cohort study was performed at a single center. Patients with Ebstein anomaly of the tricuspid valve were excluded. The primary outcome was all-cause mortality, whereas the secondary outcome was a composite endpoint encompassing all-cause mortality, need for tricuspid valve re-operation or heart transplant, and readmission due to congestive heart failure.

Results:

Early mortality was 4.2%, with 5- and 10-year survival rates of 82.4 ± 1.9% and 71.7 ± 2.8%, respectively. Independent determinants of mortality included age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.01-1.05), male gender (HR, 1.96; 95% CI, 1.29-2.99), New York Heart Association functional class IV (HR, 2.08; 95% CI, 1.11-5.68), presence of liver cirrhosis (HR, 2.51; 95% CI, 1.11-5.68), and preoperative levels of hemoglobin (HR, 0.89; 95% CI, 0.8-0.99), albumin (HR, 0.52; 95% CI, 0.33-0.81), and estimated glomerular filtration rate (HR, 0.86; 95% CI, 0.78-0.95). Procedural type (repair vs. replacement, p = 0.58) or causes of TR (p = 0.97) were not predictive of mortality.

Conclusions:

The authors concluded that long-term survival after tricuspid valve surgery is affected by preoperative patient factors including heart failure symptoms, end-organ dysfunction, and laboratory abnormalities, but not by the type of surgery or causes of TR.

Perspective:

This single-center study reported short- and intermediate-term outcomes after surgery for severe TR. Importantly, patients with Ebstein anomaly of the tricuspid valve were not included in the analysis. This study demonstrates that patients with significant symptoms or end-organ dysfunction had poorer outcomes with surgical intervention. The authors advocate intervention prior to the development of severe symptoms or laboratory abnormalities. From a practical standpoint, determining the optimal timing of intervention for this patient population will remain a challenge.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD & Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD & Pediatrics and Interventions, CHD & Pediatrics and Quality Improvement, Acute Heart Failure, Heart Transplant, Interventions and Structural Heart Disease

Keywords: Heart Diseases, Heart Defects, Congenital, Tricuspid Valve Insufficiency, Survival Rate, Heart Failure, Glomerular Filtration Rate, Ebstein Anomaly, Confidence Intervals, Liver Cirrhosis, Cardiac Surgical Procedures, Poverty, Heart Transplantation


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