Journal
THORACIC AND CARDIOVASCULAR SURGEON
Volume -, Issue -, Pages -Publisher
GEORG THIEME VERLAG KG
DOI: 10.1055/a-2048-8199
Keywords
tricuspid valve; surgery; complications; outcomes; heart valve surgery
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By analyzing the data from 369 patients undergoing isolated tricuspid valve surgery, the study found that the surgical approaches and pre- and postoperative valve function were associated with the expected mortality rates. The majority of patients showed improved tricuspid valve function postoperatively. Randomized controlled trials are needed to compare the long-term outcomes of surgical and interventional procedures.
Background Isolated tricuspid valve surgery has been associated with earlymortality rates of up to 10%. With rapidly emerging interventional catheter-based options, the question arises whether current technical and perioperative protocols in cardiac surgery translate into lower than previously expected mortality rates, especially when looking at data from high-volume centers. Methods We performed a retrospective single-center analysis in 369 patients undergoing isolated tricuspid valve repair (n = 256) or replacement (n = 113) between 2009 and 2021. Surgical approaches included full sternotomy, as well as right-sided minithoracotomy. According to a recently introduced clinical risk score, patients were divided into scoring groups, and observed (O) versus expected (E) early mortality were compared. Pre- and postoperative tricuspid valve function was also analyzed. Results Overall, 30-day mortality was 4.1%, ranging from 0% (scoring group 0-1 points) to 8.7% (scoring group >= 10 points), which was substantially lower than the expected early mortality (2% in the lowest to 34% in the highest scoring group). Preoperative tricuspid regurgitation was severe in 71.3% (n= 263), moderate to severe in 14.9% (n = 55), and mild or less in 6.5% (n = 24). The corresponding postoperative values were 0% (n= 0), 1.4% (n = 5), and 81.6% ( n = 301). Conclusion Our high-volume center data indicate substantially lower than predicted 30- day mortality in different cardiac surgical risk scoring groups. The majority of patients had zero to minimal residual tricuspid valve insufficiency postoperatively. Randomized controlled trials are needed to compare tricuspid valve functional results and long- term outcomes of surgical versus interventional procedures in patients undergoing isolated tricuspid valve procedures.
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