title: Should Moderate-to-Severe Tricuspid Regurgitation be Repaired During Reoperative Left-Sided Valve Procedures?
abstract: The risks vs benefits of tricuspid valve (TV) surgery in reoperative patients requiring left-sided valve surgery and moderate-to-severe tricuspid regurgitation is unclear. We compared patients with and without concomitant TV surgery. A total of 200 patients with moderate-to-severe TV regurgitation had reoperative left-sided valve procedures from January 2002 to April 2014; 75 with TV intervention (TVI) and 125 with no tricuspid intervention (TVN). Propensity-matched cohorts of 60 TVI and 60 TVN patients were compared. Outcomes included New York Heart Association class, TV regurgitation and survival. TVI patients were younger (66 ± 15 vs 72 ± 13 years, P < 0.001), had more cardiogenic shock (6 of 75, vs 0 of 125, P < 0.001) and mitral valve surgery (60 of 75 vs 69 of 125, P < 0.001). Propensity matching yielded 60 pairs of TVI cases and TVN controls. Matched groups were comparable in age (TVI = 67 ± 13 vs TVN 68 ± 14 years, P = 0.67), cardiogenic shock (2 vs 0, P = 0.50), and mitral valve surgery (15 each, P = 1.0). Operative mortality was 2 of 60 in TVI vs 10 of 60 TVN (P = 0.27). Median follow-up was 4.4 years. Follow-up rates of New York Heart Association class III-IV were similar (12 of 60 for TVI vs 16 of 60 TVN, P = 0.52). Kaplan-Meier analysis indicated improved event-free survival for TVI patients (6 years, 95% CI: 4.8-7.2 years vs 8 years, 95% CI: 6.7-9.3 years for TVN, P = 0.030). There was a trend towards increased TR at follow-up in patients with valve repair alone vs annuloplasty (P = 0.15). TV surgery was performed more often in higher-risk patients. Matched case-control analyses showed TVI was associated with improved midterm outcomes. Our data suggest that annuloplasty was preferable to TV repair alone.
authors: Division of Cardiac Surgery, Brigham and Women׳s Hospital, Boston Massachusetts.
authors: Igor
authors: I
authors: Gosev
authors: Division of Cardiac Surgery, Brigham and Women׳s Hospital, Boston Massachusetts.
authors: Maroun
authors: M
authors: Yammine
authors: Division of Cardiac Surgery, Brigham and Women׳s Hospital, Boston Massachusetts.
authors: Siobhan
authors: S
authors: McGurk
authors: Division of Cardiac Surgery, Brigham and Women׳s Hospital, Boston Massachusetts.
authors: Julius I
authors: JI
authors: Ejiofor
authors: Division of Cardiac Surgery, Brigham and Women׳s Hospital, Boston Massachusetts.
authors: Anthony
authors: A
authors: Norman
authors: Division of Cardiac Surgery, Brigham and Women׳s Hospital, Boston Massachusetts.
authors: Vladimir
authors: V
authors: Ivkovic
authors: Division of Cardiac Surgery, Brigham and Women׳s Hospital, Boston Massachusetts. Electronic address: Igor.gosev@umassmemorial.org.
authors: Lawrence H
authors: LH
authors: Cohn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D057216:Propensity Score; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*
keywords: Aortic Valve Surgery; Mitral Valve Surgery; Reoperative Cardiac Surgery; Tricuspid Regurgitation; Tricuspid Valve