title: Preoperative Predictors and Outcome of Triple Valve Surgery in 487 Consecutive Patients.
abstract: BackgroundTriple valve surgery (TVS) is associated with an elevated risk for operative mortality and thus remains a surgical challenge. We report our experience and results of TVS procedures, especially with respect to identification of preoperative risk factors, to improve patient selection.MethodsBetween December 1994 and January 2013, 487 consecutive patients (240 male, 247 female) underwent TVS at the Heart Center Leipzig, University of Leipzig. The data were prospectively collected and retrospectively analyzed. Univariate and multivariable regression analyses were performed to identify risk factors.ResultsThe 30-day mortality was 16.1% and the long-term survival at 1 year and 5 years was 71.8% and 54.6%, respectively. Multivariable logistic regression analysis identified previous myocardial infarction to be the only significant predictor for early mortality. Age, New York Heart Association functional class IV, previous myocardial infarction, dialysis, and liver dysfunction were identified as preoperative predictors for late mortality. Furthermore, an increase of operative risk, given for each year, was observed during the study period. In contrast, 30-day mortality decreased during the observation time.ConclusionTVS is associated with a high surgical risk. Long-term survival is decreased, but acceptable for these high-risk patients. The series demonstrates that increasing surgical risk, age, and comorbidities are the future challenges in TVS.
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Noack
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Emrich
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kiefer
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany.
authors.forename: Alexandro
authors.initials: A
authors.lastname: Hoyer
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany.
authors.forename: David Michael
authors.initials: DM
authors.lastname: Holzhey
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany.
authors.forename: Piroze
authors.initials: P
authors.lastname: Davierwala
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany.
authors.forename: Farhad
authors.initials: F
authors.lastname: Bakhtiary
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Seeburger
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig University, Leipzig, Germany.
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*