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. 2017 Oct 26;9(10):787-793.
doi: 10.4330/wjc.v9.i10.787.

Clinical outcomes of tricuspid valve repair accompanying left-sided heart disease

Kasra Azarnoush  1 , Ahmad S Nadeemy  2 , Bruno Pereira  3 , Massoud A Leesar  4 , Céline Lambert  3 , Alaa Azhari  5 , Vedat Eljezi  5 , Nicolas Dauphin  5 , Etienne Geoffroy  5 , Lionel Camilleri  5
Affiliations

Clinical outcomes of tricuspid valve repair accompanying left-sided heart disease

Kasra Azarnoush et al. World J Cardiol. .

Abstract

Aim: To determine whether the need for additional tricuspid valve repair is an independent risk factor when surgery is required for a left-sided heart disease.

Methods: One hundred and eighty patients (68 ± 12 years, 79 males) underwent tricuspid annuoplasty. Cox proportional-hazards regression model for multivariate analysis was performed for variables found significant in univariate analyses.

Results: Tricuspid regurgitation etiology was functional in 154 cases (86%), organic in 16 cases (9%), and mixed in 10 cases (6%), respectively. Postoperative mortality at 30 days was 11.7%. Mean follow-up was 51.7 mo with survival at 5 years of 73.5%. Risk factors for mortality were acute endocarditis [hazard ratio (HR) = 9.22 (95%CI: 2.87-29.62), P < 0.001], ischemic heart disease requiring myocardial revascularization [HR = 2.79 (1.26-6.20), P = 0.012], and aortic valve stenosis [HR = 2.6 (1.15-5.85), P = 0.021]. Significant predictive factors from univariate analyses were double-valve replacement combined with tricuspid annuloplasty [HR = 2.21 (1.11-4.39), P = 0.003] and preoperatively impaired ejection fraction [HR = 1.98 (1.04-3.92), P = 0.044]. However, successful mitral valve repair showed a protective effect [HR = 0.32 (0.10-0.98), P = 0.046]. Additionally, in instances where tricuspid regurgitation required the need for concomitant tricuspid valve repair, mortality predictor scores such as Euroscore 2 could be shortened to a simple Euroscore-tricuspid comprised of only 7 inputs. The explanation may lie in the fact that significant tricuspid regurgitation following left-sided heart disease represents an independent risk factor encompassing several other factors such as pulmonary arterial hypertension and dyspnea.

Conclusion: Tricuspid annuloplasty should be used more often as a concomitant procedure in the presence of relevant tricuspid regurgitation, although it usually reveals an overly delayed correction of a left-sided heart disease.

Keywords: Infective endocarditis; Mitral valve annuloplasty; Patient outcome assessment; Tricuspid regurgitation; Valvular annuloplasty.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare having no conflicts of interest.

Figures

Figure 1
Figure 1
Overall patient survival.
Figure 2
Figure 2
ROC curve comparing Euroscore 2 and Euroscore-tricuspid.
See this image and copyright information in PMC

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