AI Article Synopsis
- The study aims to evaluate whether the need for tricuspid valve repair poses an independent risk when performing surgery for left-sided heart diseases, involving 180 patients undergoing tricuspid annuloplasty.
- Findings show that the majority of patients had functional tricuspid regurgitation, with a postoperative mortality of 11.7% at 30 days and a 5-year survival rate of 73.5%, identifying specific risk factors for mortality.
- The research concludes that tricuspid annuloplasty should be more frequently performed alongside other heart surgeries due to its significance as a risk factor, suggesting a simpler mortality predictor score that includes tricuspid-related inputs.
Article 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), < 0.001], ischemic heart disease requiring myocardial revascularization [HR = 2.79 (1.26-6.20), = 0.012], and aortic valve stenosis [HR = 2.6 (1.15-5.85), = 0.021]. Significant predictive factors from univariate analyses were double-valve replacement combined with tricuspid annuloplasty [HR = 2.21 (1.11-4.39), = 0.003] and preoperatively impaired ejection fraction [HR = 1.98 (1.04-3.92), = 0.044]. However, successful mitral valve repair showed a protective effect [HR = 0.32 (0.10-0.98), = 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.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661134 | PMC |
| http://dx.doi.org/10.4330/wjc.v9.i10.787 | DOI Listing |
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