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. 2021 Oct;11(5):1058-1066.
doi: 10.21037/cdt-21-311.

Early surgery can improve the outcomes of patients with severe tricuspid regurgitation undergoing tricuspid replacement

Kun Hua #  1 , Rui Zhao #  2 , Zhan Peng  1 , Yunxiao Yang  1 , Osmanaj Florian  1 , Bin Mao  1 , Xiubin Yang  1   2
Affiliations

Early surgery can improve the outcomes of patients with severe tricuspid regurgitation undergoing tricuspid replacement

Kun Hua et al. Cardiovasc Diagn Ther. 2021 Oct.

Abstract

Background: Tricuspid regurgitation (TR) usually remains asymptomatic for a long time, such that it is most often diagnosed at an advanced stage of right heart failure. The purpose of this study was to identify clinical characteristics and overall outcomes in patients with severe TR who received tricuspid valve replacement (TVR) at different clinical stages.

Methods: Between 1993 and 2018, 256 severe TR patients who received TVR alone or in combination with other procedures were assessed at Beijing Anzhen Hospital. Ninety-three patients underwent New York Heart Association (NYHA) class I/II operations (early surgery group), and the others underwent NYHA class III/IV operations. The primary outcome was in-hospital and long-term mortality. Clinical outcomes were evaluated by the Kaplan-Meier method and Cox regression models. Follow-up was conducted annually. Propensity score matching and overlap propensity score weighting were performed as sensitivity analyses.

Results: Postoperative complications, including low cardiac output (11.8% vs. 26.4%, P<0.001), renal failure (2.2% vs. 16.6%, P<0.001), and bleeding (3.2% vs. 11.7%, P=0.037), were significantly lower in the NYHA class I/II group than in the NYHA III/IV group. Patients in the NYHA class III/IV group had a significantly higher incidence of in-hospital mortality (18.4% vs. 5.4%, P<0.001) and long-term mortality (33.7% vs. 11.8%, P=0.006) after follow-up (median follow-up duration =63 months). The results indicated a consistently higher occurrence rate in the propensity score-matched cohort and overlap propensity score weighted analysis.

Conclusions: Consistent with the recent clinical trend to provide earlier and more aggressive TR intervention, our results indicate that surgery for severe TR patients should be considered before advanced heart failure develops, when patients are asymptomatic or mildly symptomatic (NYHA class I/II).

Keywords: New York Heart Association classification (NYHA classification); Tricuspid regurgitation; tricuspid surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/cdt-21-311). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study design: summary of inclusion and exclusion criteria of study population. NYHA, New York Heart Association; TR, tricuspid regurgitation; TVR, tricuspid valve replacement.
Figure 2
Figure 2
Kaplan-Meier curves with corresponding numbers at-risk for overall survival by NYHA class. NYHA, New York Heart Association.
Figure 3
Figure 3
Standardized mean differences for NYHA pairwise comparisons. AF, atrial fibrillation; BMI, body mass index; EF, ejection fraction; NYHA, New York Heart Association; SMD, standardized mean difference.
See this image and copyright information in PMC

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