title: Postoperative tricuspid regurgitation after adult congenital heart surgery is associated with adverse clinical outcomes.
abstract: OBJECTIVE
  Many patients with adult congenital heart disease will require cardiac surgery during their lifetime, and some will have concomitant tricuspid regurgitation. However, the optimal management of significant tricuspid regurgitation at the time of cardiac surgery remains unclear. We assessed the determinants of adverse outcomes in patients with adult congenital heart disease and moderate or greater tricuspid regurgitation undergoing cardiac surgery for non-tricuspid regurgitation-related indications.
  
  
  METHODS
  All adult patients with congenital heart disease and greater than moderate tricuspid regurgitation who underwent cardiac surgery for non-tricuspid regurgitation-related indications were included in a retrospective study at the Schneeweiss Adult Congenital Heart Center. Cohorts were defined by the type of tricuspid valve intervention at the time of surgery. The primary end point of interest was a composite of death, heart transplantation, and reoperation on the tricuspid valve.
  
  
  RESULTS
  A total of 107 patients met inclusion criteria, and 17 patients (17%) reached the primary end point. A total of 68 patients (64%) underwent tricuspid valve repair, 8 patients (7%) underwent tricuspid valve replacement, and 31 patients (29%) did not have a tricuspid valve intervention. By multivariate analysis, moderate or greater postoperative tricuspid regurgitation was associated with a hazard ratio of 6.12 (1.84-20.3) for the primary end point (P = .003). In addition, failure to perform a tricuspid valve intervention at the time of surgery was associated with an odds ratio of 4.17 (1.26-14.3) for moderate or greater postoperative tricuspid regurgitation (P = .02).
  
  
  CONCLUSIONS
  Moderate or greater postoperative tricuspid regurgitation was associated with an increased risk of death, transplant, or reoperation in adult patients with congenital heart disease undergoing cardiac surgery for non-tricuspid regurgitation-related indications. Concomitant tricuspid valve intervention at the time of cardiac surgery should be considered in patients with adult congenital heart disease with moderate or greater preoperative tricuspid regurgitation.
authors.affiliation: Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heat Center, Columbia University Medical Center, New York, NY. Electronic address: ml3329@cumc.columbia.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Lewis
authors.affiliation: Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heat Center, Columbia University Medical Center, New York, NY; Division of Thoracic Imaging, Department of Radiology, Columbia University Medical Center, New York, NY.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Ginns
authors.affiliation: Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY.
authors.forename: Siqin
authors.initials: S
authors.lastname: Ye
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Paul
authors.initials: P
authors.lastname: Chai
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Quaegebeur
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Emile
authors.initials: E
authors.lastname: Bacha
authors.affiliation: Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heat Center, Columbia University Medical Center, New York, NY.
authors.forename: Marlon S
authors.initials: MS
authors.lastname: Rosenbaum
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult
keywords: congenital heart disease; tricuspid regurgitation; tricuspid valve repair