Long-term outcomes of concomitant tricuspid valve repair in patients undergoing mitral valve surgery

Ayse Cetinkaya,Manfred Richter,Natalia Ganchewa,Karin Bramlage,Markus Schönburg,Peter Bramlage,Stefan Hein

doi:10.1186/s13019-020-01244-6

Ayse Cetinkaya, Manfred Richter + Show 5 more

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https://doi.org/10.1186/s13019-020-01244-6

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Abstract

BackgroundWe aimed to find out how the concomitant performance of tricuspid valve repair (TVR) affects outcomes of patients undergoing mitral valve surgery (MVS).MethodsSingle-centre, retrospective analysis of 1357 patients who underwent MVS between January 2005 and December 2015, including 1165 patients with isolated MVS and 192 patients with MVS plus TVR. We used propensity scores to match patients for baseline characteristics other than valve related parameters and arrived at a matched sample of 182 patients per group.ResultsThe overall procedure duration was longer in the MVS + TVR (224 min) versus the MVS group (176 min; p < 0.001), as were the duration of mechanical ventilation (13 vs. 11 h; p < 0.001), X-clamp (90.5 vs. 66 min; p < 0.001) and cardiopulmonary bypass time (136 vs. 95.5 min; p < 0.001). Rates of procedural complications were not different between groups with the exception of pacemaker rates which were 16.0% in the MVS + TVR group and 8.8% in the isolated MVS group (p = 0.037).There was no difference in death rates within 30 days, stroke, myocardial infarction or repeat MVS. The long-term survival rate was 60.8% in the MVS + TVR vs. 57.5% in the isolated MVS group (HR 1.048; 95%CI 0.737–1.492; p = 0.794). The rate of grade III/IV tricuspid regurgitation (TR) remained low after MVS + TVR during long-term follow-up while the rate of grade ≥ II TR increased slightly in the isolated MVS group.ConclusionThe data show that the concomitant performance of TVR in patients undergoing MVS is a safe and effective procedure with good long-term outcomes. Patients can undergo MVS + TVR with confidence as it improves their prognosis up to the level of patients undergoing isolated MVS.

Highlights

Patients requiring mitral valve (MV) surgery (MVS) often suffer from concomitant tricuspid valve (TV) regurgitation (TR)
Physicians who take a conservative approach would only intervene on the tricuspid valve in parallel to mitral valve surgery (MVS) in cases with severe tricuspid regurgitation (TR) or risk factors for progression of TR, because they usually expect that MVS will restore tricuspid valve function in less than severe cases
We aimed to explore the impact of concomitant tricuspid valve repair (TVR) at the time of MVS on procedural parameters, procedure-related and 30-day complications, and long-term survival and to compare it with the outcomes of isolated MVR

Summary

Introduction

Patients requiring mitral valve (MV) surgery (MVS) often suffer from concomitant tricuspid valve (TV) regurgitation (TR). Whether or not to manage concomitant TR at the time of mitral valve (MV) surgery (MVS). It is a difficult situation to explain patients that they need to undergo concomitant TVR as the procedure usually takes longer and the potential increase in complications may exceed the benefit. Physicians who manage TVR more aggressively usually do so because of the increased mortality and morbidity associated with repeat surgery for TVR performed after MVS, and because concomitant TVR is generally a safe procedure [4, 5]. We aimed to find out how the concomitant performance of tricuspid valve repair (TVR) affects outcomes of patients undergoing mitral valve surgery (MVS)

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