Surgery For Severe Tricuspid Regurgitation Research Articles

A new risk-score model to predict in-hospital mortality after isolated tricuspid valve surgery for severe tricuspid regurgitation

Isolated tricuspid valve surgery (ITVS) is reputed to be a high-risk surgery, but in-hospital mortality is markedly variable. This study sought to develop a dedicated risk score model to predict the outcome of patients after ITVS for severe tricuspid regurgitation (TR). All consecutive adult patients who underwent an ITVS for severe TR at 12 French centers between 2007 and 2017 were included. We derived and internally validated a scoring system to predict in-hospital mortality using multivariable logistic regression and bootstrapping with 1000 re-samples. We identified 466 patients (60 ± 16 years, 49% female, functional TR in 49%). In-hospital mortality rate was 10%. The final risk score ranged from 0 to 12 points and included 8 parameters: age ≥ 70 years, New-York Heart Association class III-IV, right-sided heart failure signs, daily dose of furosemide ≥ 125 mg, glomerular filtration rate < 30 ml/min, elevated bilirubin, left-ventricular ejection fraction < 60% and moderate/severe right-ventricular dysfunction. TR mechanism was not an independent predictor of outcome. Observed and predicted in-hospital mortality rates increased from 0% to 60% and from 1% to 65% respectively as score increased from 0 up to ≥ 9 points. Apparent and bias-corrected areas under the receiver operating characteristic curves were 0.81 and 0.75 respectively, much higher than the logistic EuroSCORE (0.67) or EuroSCORE II (0.63). We proposed an accurate dedicated risk-score model based on eight easy to ascertain parameters to inform patients and physicians regarding the risk of ITVS and guide the clinical decision-making process of patients with severe TR, especially as transcatheter therapies are emerging.

The impact of pulmonary artery banding and cardiac resynchronization therapy for the adult patient with congenitally corrected transposition of the great arteries

It has been controversial how to manage severe dysfunction of the systemic right ventricle and severe tricuspid regurgitation for adult patients with congenitally corrected transposition of the great arteries. We reported a 43-year-old man with these disorders, who received pulmonary artery banding and cardiac resynchronization therapy without cardiopulmonary bypass. The degree of the tricuspid regurgitation was improved to mild-moderate and systemic right ventricular ejection fraction was improved from 28 to 45% after surgery. Cardiopulmonary exercise testing showed that the predictive value of anaerobic threshold and peak oxygen uptake improved from 65 to 99% and 59 to 92%, respectively. In conclusion, pulmonary artery banding and cardiac resynchronization therapy can be the first choice of surgery for severe tricuspid regurgitation with severely impaired systemic right ventricular function. After improving systemic right ventricular dysfunction tricuspid surgery could be the next choice as a surgical intervention in the future.

Short- and long-term outcomes of surgery for severe tricuspid regurgitation: Algerian experience

There is little data available for Algeria on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. Retrospective study in 239 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 2006 and February 2014 in military hospitals of Algeria and Constantine. A total of 112 ringless and 85 ring annuloplasties were performed and 9 bioprostheses and 33 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24–89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age >70 years and extracorporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty ( P = 0.04). Ringless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement.

Tricuspid valve surgery in implantable cardiac electronic device-related endocarditis: Repair or replace?

The aim of this study was to investigate lead endocarditis-related tricuspid valve regurgitation, to identify underlying causes, and to report our surgical approaches to tricuspid valve endocarditis. Between March 2010 and August 2016, medical records of a total of 43 patients (23 males, 20 females; mean age: 63.2±13.6 years; range 48 to 72 years) who underwent tricuspid valve surgery for severe tricuspid regurgitation caused by lead endocarditis, which was previously placed as an implantable cardiac electronic device were reviewed. We removed all systems including infected leads and generators, revised infected wounds and tissues, performed tricuspid valve surgery for lead endocarditis, and applied long-term intravenous antibiotic regimen for the culprit agent, as confirmed by the culture. Of 43 patients, 18 underwent tricuspid valve repair and 25 underwent tricuspid valve replacement for lead endocarditisrelated severe tricuspid valve regurgitation. During followup (range, 2 to 62 months), two patients required temporary mechanical support due to postoperative acute right heart failure, while eight patients died due to sepsis (n=6; 14%) and stroke (n=2; 4.6%) in the early postoperative period. The remaining patients showed significant improvement in signs and symptoms of heart failure. Our study results suggest that incompetent experience and inaccurate decision for valve repair may result in delayed valve replacement and prolonged operation time.

Percutaneous tricuspid valve replacement: orthotopic and heterotopic valves.

The tricuspid valve has long been described as the "forgotten valve", leaving tricuspid valve disease relatively neglected. However, the number of people in the United States affected by severe tricuspid regurgitation is growing. Isolated surgery for severe tricuspid regurgitation in the setting of right ventricular heart failure carries a high mortality risk, and therefore, attention to corrective therapies has increased. Because of the different etiologies for tricuspid regurgitation, multiple percutaneous transcatheter options for tricuspid valve repair for severe regurgitation are being studied and have been developed, including annuloplasty systems, leaflet and coaptation devices, vena caval (heterotopic) valve implantations, and tricuspid valve (orthotopic) replacement. In this paper, we review the heterotopic and orthotopic tricuspid valve transcatheter options for severe tricuspid regurgitation.

0263: Short- and long-term outcomes of surgery for severe tricuspid regurgitation: Algerian experience

There is little data available for Algeria on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. Retrospective study in 239 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 2006 and February 2014 in military hospitals of Algeria and Constantine. A total of 112 ringless and 85 ring annuloplasties were performed and 9 bioprostheses and 33 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24-89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age>70 years and extra-corporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty (P=.04). Ringless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement.

Short- and Long-term Outcomes of Surgery for Severe Tricuspid Regurgitation

Introduction and objectivesThere is little data available for Spain on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. MethodsRetrospective study in 119 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 1996 and February 2010. ResultsA total of 61 ringless and 23 ring annuloplasties were performed and 11 bioprostheses and 24 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24-89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age>70 years and extracorporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty (P=.04). ConclusionsRingless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement.

Prediction of Outcome in Patients Undergoing Surgery for Severe Tricuspid Regurgitation Following Mitral Valve Surgery and Role of Tricuspid Annular Systolic Velocity

This study was performed to identify echocardiographic parameters related to postoperative clinical outcome in patients who undergo surgery for severe tricuspid regurgitation after mitral valve surgery. Eighteen patients (2 men, 16 women; mean age 58 years) were prospectively enrolled. Echocardiographic examinations were performed before and 15 +/- 7 months after surgery. Favorable postoperative clinical outcome was defined as an improvement of > or = 1 in New York Heart Association functional class or a > 25% increase in respiratory variation of inferior vena cava diameter. Operative mortality was 11% (2 of 18). Of the 16 survivors, 9 (56%) achieved favorable postoperative clinical outcomes. Only systolic tricuspid annulus velocity (S'T) was found to be associated with postoperative clinical outcome (favorable vs unfavorable postoperative clinical outcome 12.9 +/- 2.1 vs 9.7+/- 1.7 cm/s, p < 0.05). For S'T < 9.5 cm/s, the sensitivity, specificity, and positive and negative predictive values for predicting an unfavorable postoperative clinical outcome were 67%, 100%, 100%, and 75%, respectively. In conclusion, S(T') can predict postoperative clinical outcomes in these patients.

Echocardiographic Parameters for Predicting the Outcome of Patients Undergoing Surgery for Severe Tricuspid Regurgitation

Background and Objectives:This study was performed to identify echocardiographic parameters related to postoperative clinical outcome (PCO) in patients undergoing surgery for severe tricuspid regurgitation (TR) following mitral valve surgery. The indications for surgery due to severe TR following mitral valve surgery are not well defined largely because of a lack of knowledge of the prognostic factors of PCO in these patients. Subjects and Methods:Eighteen patients (male/female; 2/16, mean age 58 years) with severe TR associated with prior mitral valve surgery were prospectively enrolled. Comprehensive echocardiographic examinations were performed before and 15±7 months after surgery. Favorable PCO was defined as an improvement of ≥1 in New York Heart Association (NYHA) functional class or a >25% increase in respiratory variation of IVC diameter. Nonsurvivors and survivors without a favorable PCO were defined as having an unfavorable PCO. Results:The operative mortality was 11% (2/18). Of the 16 survivors, nine (9/16, 56%) achieved a favorable PCO. NYHA functional class, age, left ventricular ejection fraction, right ventricular fractional area change, severity of TR and pulmonary artery pressure were not related to PCO. Only systolic tricuspid annulus velocity (ST') was found to be associated with PCO (favorable vs unfavorable PCO; 12.9±2.1cm/s vs 9.7±1.7cm/s, p<0.05). For ST’ value (9.5 cm/s, the sensitivity, specificity, positive and negative predictive values for predicting an unfavorable PCO were 67%, 100%, 100% and 75%, respectively. Conclusion:This study shows that ST’ can predict PCO in patients undergoing surgery for severe TR following mitral valve surgery. (Korean Circulation J 2005;35:916-920)