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. 2021 Mar;36(3):981-989.
doi: 10.1111/jocs.15337. Epub 2021 Jan 24.

Concomitant tricuspid valve surgery is beneficial at the time of left-sided valve surgery

Lauren Huckaby  1 , Laura Seese  2 , Yeahwa Hong  1 , Ibrahim Sultan  2   3 , Thomas Gleason  2   3 , Danny Chu  2   3 , Yisi Wang  3 , Arman Kilic  2   3
Affiliations

Concomitant tricuspid valve surgery is beneficial at the time of left-sided valve surgery

Lauren Huckaby et al. J Card Surg. 2021 Mar.

Abstract

Background: This study evaluates the impact of secondary functional tricuspid regurgitation (TR) and concomitant tricuspid valve repair (TVr) at the time of left-sided valve operations.

Methods: Adults undergoing left-sided valve operations between 2010 and 2019 at a multihospital academic institution were included. Patients were stratified into three groups: less-than-moderate TR without TVr (Group 1), moderate-or-greater TR without TVr (Group 2), and moderate-or-greater TR with TVr (Group 3). Primary outcomes included survival and hospital readmissions. Secondary outcomes included major postoperative morbidities. Multivariable logistic regression evaluated risk-adjusted mortality and readmission.

Results: About 3444 patients were included in the analysis and were stratified into Group 1 (n = 2612, 75.8%), Group 2 (n = 563, 16.3%), and Group 3 (n = 269, 7.8%). Patients with moderate or greater TR (Groups 2 and 3) had higher rates of mortality, hospital readmissions and major postoperative complications including reoperations, renal failure requiring dialysis, blood transfusions, and prolonged ventilation (all, p < .05). When assessed individually, the Group 3 had substantially higher rates of renal failure requiring dialysis, prolonged ventilation, and reoperations, although the Group 2 had higher rates of 30-day mortality (all, p < .05). These findings persisted in risk-adjusted analysis with the highest hazards for mortality (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.7-2.2) and readmission (HR 1.3, 95% CI 1.2-1.5) appreciated in the Group 2.

Conclusions: In this analysis of 3444 patients, those with moderate-to-severe TR who did not undergo a TVr at the time of their left-sided valve operation had substantially higher risks of mortality and hospital readmissions compared with those who did undergo TV surgery.

Keywords: mortality; readmission; tricuspid valve repair.

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