Management of tricuspid regurgitation, what is impacting mortality?

Abstract

Tricuspid regurgitation (TR) is a common condition. It is often secondary to mitral or mitro aortic pathology. Its correction is complex and requires multi-parametric analysis of the associated disease with variable results. The aim of our study is to describe management of TR and analyze mortality factors. Our series is a descriptive and analytical retrospective study and has included 41 patients with tricuspid insufficiency associated to left valvular disease admitted in Cardiology Center, Mohammed V Military Hospital of Rabat, Morocco. All of them had concomitant corrective surgery of left valvular disease with tricuspid plasty. The mean age was 50.98 years. 92.7% of patients presented dyspnea (class III of NYHA). 73.2% had atrial fibrillation and 14.63% had a creatinine value of ≥ 15 mg/L. Tricuspid plasty has been performed on 40 patients. 97.6% of those patients benefited from prosthetic ring and 4.8% from De Vega technique. Mortality was 17.07% attributed to hemodynamic failure (5 cases), multiple ischemic stokes (1 case) and septic shock (1 case). Class ≥ IV of dyspnea, atrial fibrillation, renal failure and Left ventricle dysfunction were statistically associated with mortality in our series with a value of P ˂ 0.05, which is consistent with the literature's data. Management of tricuspid insufficiency certainly requires patients’ selection among candidates requiring left valvular surgery. It is to be performed concomitantly with correction of left heart valve diseases considering the high perioperative and at long term morbidity and mortality.