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. 2020 Apr 21;7(1):e001183.
doi: 10.1136/openhrt-2019-001183. eCollection 2020.

Impact of tricuspid regurgitation on postoperative outcomes after non-cardiac surgeries

Parth Parikh  1 , Kinjal Banerjee  1 , Ambreen Ali  2 , Anil Anumandla  2 , Aditi Patel  2 , Yash Jobanputra  1 , Venu Menon  1 , Brian Griffin  1 , E Murat Tuzcu  3 , Samir Kapadia  1
Affiliations

Impact of tricuspid regurgitation on postoperative outcomes after non-cardiac surgeries

Parth Parikh et al. Open Heart. .

Abstract

Objective: Tricuspid regurgitation (TR) severity has known adverse implications, its impact on patients undergoing non-cardiac surgery (NCS) remains unclear. We sought to determine the impact of TR on patient outcomes after NCS.

Methods: We performed a retrospective cohort study in patients undergoing NCS. Outcomes in patients with moderate or severe TR were compared with no/trivial TR after adjusting for baseline characteristics and revised cardiac risk index (RCRI). The primary outcome was defined as 30-day mortality and heart failure (HF), while the secondary outcome was long-term mortality.

Results: Of the 7064 patients included, 312 and 80 patients had moderate and severe TR, respectively. Thirty-day mortality was higher in moderate TR (adjusted OR 2.44, 95% CI 1.25 to 4.76) and severe TR (OR 2.85, 95% CI 1.04 to 7.79) compared with no/trivial TR. There was no difference in 30-day HF in patients with moderate TR (OR 1.48, 95% CI 0.90 to 2.44) or severe TR (OR 1.42, 95% CI 0.60 to 3.39). The adjusted HR for long-term mortality in moderate TR was 1.55 (95% CI 1.31 to 1.82) and 1.87 (95% CI 1.40 to 2.50) for severe TR compared with no/trivial TR.

Conclusion: Increasing TR severity has higher postoperative 30-day mortality in patients undergoing NCS, independent of RCRI risk factors, ejection fraction or mitral regurgitation. Severity of TR should be considered in risk stratification for patients undergoing NCS.

Keywords: non-cardiac surgery; outcomes; tricuspid regurgitation.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart showing the inclusion criteria and selection of the final cohort. TR, tricuspid regurgitation.
Figure 2
Figure 2
Forest plot showing the multivariate analysis for primary outcome. (A) Forest plot diagram for the multivariate analysis for mortality at 30 days with the different grades of TR compared with no TR. (B) Forest plot diagram for the multivariate analysis for heart failure at 30 days with the different grades of TR compared with no TR. CAD, coronary artery disease; CVA, cerebrovascular accident; EF, ejection fraction; IHD, ischaemic heart disease; MR, mitral regurgitation; TR, tricuspid regurgitation.
Figure 3
Figure 3
Kaplan-Meier survival estimates. †P=0.009 when compared with no/mild TR|low PASP. *P<0.001 when compared to no/mild TR|Low PASP. (A) Kaplan-Meier survival estimates in patients based on grade of TR and pulmonary artery systolic pressure. (B) Kaplan-Meier survival estimates in patients based on grade of TR for the entire cohort. PASP, pulmonary artery systolic pressure; TR, tricuspid regurgitation.
Figure 4
Figure 4
Predictors of 30-day mortality and HF in patients with tricuspid regurgitation. CVA, cerebrovascular accident; EF, ejection fraction; CAD, coronary artery disease; MR, mitral regurgitation; TR, tricuspid regurgitation.
See this image and copyright information in PMC

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