Prognostic factors of morbidity-mortality of isolated tricuspid valve surgery (ITVS)

Abstract

Moderate and severe TR is a prognostic marker of mortality independently from right ventricular dysfunction, pulmonary hypertension and left ventricular dysfunction. The survival benefit of ITVS is controversial. The aim of this study is to define the clinical and paraclinical criteria associated with morbidity-mortality of ITVS. We conducted a single-centre, retrospective study of 69 patients who underwent an ITVS at Marseille University Hospital from 2008 to 2018. Combined left-heart surgery and congenital cardiopathy were excluded. The primary outcome (PO) is composite including death and rehospitalization for acute decompensated heart failure within a year after surgery. Nineteen patients were treated for secondary tricuspid regurgitation (TR) (15 TR following left-sided valvulopathy and 4 TR caused by chronic atrial fibrillation (AF)). Forty-four had an operation for primary TR (36.5% of total TR were endocarditis). Mean patient follow-up was 44.5 months. Thirty-seven % of patients with secondary TR met the PO versus 9% of others ( P = 0.011). Preoperative signs of chronic right heart failure (NYHA, congestive signs, anaemia and hyponatremia) were significantly linked with our PO. Right ventricular systolic pressure collected by preoperative right heart catheterization was a marker of unfavourable postoperative prognosis, confirmed by multivariate analysis ( P = 0.006). Survival was worse for secondary TR (two years after surgery, 50% of patients with secondary TR were still alive and had not been readmitted versus 75% of others, P = 0.01). Isolated surgery of functional TR, whether caused by pulmonary hypertension secondary to left heart disease or due to right atrial dilatation (linked to AF) without a downstream obstacle, had a high morbidity-mortality risk in the short-term. Right heart catheterization may help in targeting high-risk surgical patients with secondary TR for percutaneous treatment.