Journal
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Volume 162, Issue 1, Pages 44-+Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2020.02.033
Keywords
aortic valve replacement; tricuspid regurgitation; tricuspid valve repair
Funding
- National Heart, Lung, and Blood Institute [T32 HL007849]
- National Institutes of Health [UM1 HL088925]
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The study found that increasing severity of TR is associated with higher rates of morbidity and mortality after AVR. Correcting TR at the time of surgical AVR is not associated with increased operative mortality and has been shown to improve long-term outcomes.
Background: Long-term outcomes of aortic valve replacement (AVR) are worse in patients with tricuspid regurgitation (TR), but the impact of concomitant tricuspid valve intervention remains unclear. The purpose of this study was to determine the effect of tricuspid intervention in patients with TR undergoing AVR. Methods: Patients undergoing AVR in a regional Society of Thoracic Surgeons database (2001-2017) were stratified by severity of TR and whether or not they underwent concomitant tricuspid intervention. Operative morbidity and mortality were compared between the 2 groups. Further analysis was performed using propensity score-matched pairs. Results: Among 17,483 patients undergoing AVR, 8984 (51%) had no TR, 7252 (41%) had mild TR, 1060 (6%) had moderate TR, and 187 (1%) had severe TR. Overall, more severe TR was associated with higher morbidity and mortality. Tricuspid intervention was performed in 104 patients (0.6%), including 0.2% of patients with mild TR, 2% of those with moderate TR, and 31% of those with severe TR. In the propensity score-matched analysis, there was not a statistically significant difference in operative mortality between the 2 groups (18% vs 9%; P = .16), but there was significantly higher composite major morbidity (51% vs 26%; P = .006) in the tricuspid intervention group compared with those without surgical TR correction. Conclusions: Increasing severity of TR is associated with higher rates of morbidity and mortality after AVR. Correction of TR at the time of surgical AVR is not associated with increased operative mortality and has been shown to improve long-term outcomes.
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