Julien Dreyfus1, Michele Flagiello2, Baptiste Bazire3, Florian Eggenspieler4, Florence Viau5, Elisabeth Riant6, Yannick Mbaki7, Yohann Bohbot8,9, Damien Eyharts10, Thomas Senage11, Henri Dubrulle12, Martin Nicol1, Fabien Doguet13,14, Virginia Nguyen1, Augustin Coisne12,15, Thierry Le Tourneau16, Yoan Lavie-Badie10, Christophe Tribouilloy8,9, Erwan Donal7, Jacques Tomasi17, Gilbert Habib5,18, Christine Selton-Suty4, Richard Raffoul19, Bernard Iung20, Jean-François Obadia2, David Messika-Zeitoun21. 1. Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France. 2. Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, 59 Boulevard Pinel, 69500 Bron, France. 3. Department of Cardiology, Bichat Claude Bernard Hospital, 46 Rue Henri Huchard, 75018 Paris, France. 4. Department of Cardiology, University Hospital of Nancy-Brabois, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France. 5. Cardiology Department, APHM, La Timone Hospital, 278 Rue Saint-Pierre, 13005 Marseille, France. 6. Cardiology Department, Expert Valve Center, Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. 7. Cardiology Department, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes-1, 2 Rue Henri le Guilloux, 35000 Rennes, France. 8. Department of Cardiology, Amiens University Hospital, 1 Rue du Professeur Christian Cabrol, 80054 Amiens, France. 9. UR UPJV 7517, Jules Verne University of Picardie, 51 Boulevard de Châteaudun, 80000 Amiens, France. 10. Department of Cardiology, Rangueil University Hospital, 9 Place Lange, 31300 Toulouse, France. 11. Department of Cardiac Surgery, INSERM 1246, Université de Nantes, CHU de Nantes, 8 Quai Moncousu, 44007 Nantes, France. 12. Department of Clinical Physiology and Echocardiography - Heart Valve Clinic, CHU Lille, 2 Avenue Oscar Lambret, 59000 Lille, France. 13. Service de chirurgie cardiovasculaire et thoracique, CHU Charles Nicolle, 37 Boulevard Gambetta, 76000 Rouen, France. 14. Normandie Univ, Unirouen, INSERM U1096, Rouen 76000, France. 15. Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, Lille F-59000, France. 16. Université de Nantes, CHU de Nantes, CNRS, INSERM, l'institut du thorax, Nantes F-44000, France. 17. Department of Cardiac Surgery, CHU de RENNES, Université de Rennes-1, 2 Rue Henri le Guilloux, 35000 Rennes, France. 18. Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France. 19. Department of Cardiac Surgery, AP-HP, Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France. 20. Cardiology Department, AP-HP, DHU Fire, Bichat Hospital, Université de Paris, 46 Rue Henri Huchard, 75018 Paris, France. 21. Department of Cardiology, University of Ottawa Heart Institute, 40 ruskin street, Ottawa, Ontario, Canada.
Abstract
AIMS: The aim of this study was to identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) and more specifically the impact of tricuspid regurgitation (TR) mechanism and clinical presentation. METHODS AND RESULTS: Among 5661 consecutive adult patients who underwent a tricuspid valve (TV) surgery at 12 French tertiary centres in 2007-2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease [47% in New York Heart Association (NYHA) III/IV, 57% with right-sided heart failure (HF) signs]. Tricuspid regurgitation was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31%, respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14% vs. 6%, P = 0.004), but presentation was more severe. Independent determinants of outcomes were NYHA Class III/IV [odd ratios (OR) = 2.7 (1.2-6.1), P = 0.01], moderate/severe right ventricular dysfunction [OR = 2.6 (1.2-5.8), P = 0.02], lower prothrombin time [OR = 0.98 (0.96-0.99), P = 0.008], and with borderline statistical significance, right-sided HF signs [OR = 2.4 (0.9-6.5), P = 0.06] while TR mechanism was not [OR = 0.7 (0.3-1.8), P = 0.88]. CONCLUSION: Isolated TV surgery was associated with high mortality and morbidity, both in hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The aim of this study was to identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) and more specifically the impact of tricuspid regurgitation (TR) mechanism and clinical presentation. METHODS AND RESULTS: Among 5661 consecutive adult patients who underwent a tricuspid valve (TV) surgery at 12 French tertiary centres in 2007-2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease [47% in New York Heart Association (NYHA) III/IV, 57% with right-sided heart failure (HF) signs]. Tricuspid regurgitation was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31%, respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14% vs. 6%, P = 0.004), but presentation was more severe. Independent determinants of outcomes were NYHA Class III/IV [odd ratios (OR) = 2.7 (1.2-6.1), P = 0.01], moderate/severe right ventricular dysfunction [OR = 2.6 (1.2-5.8), P = 0.02], lower prothrombin time [OR = 0.98 (0.96-0.99), P = 0.008], and with borderline statistical significance, right-sided HF signs [OR = 2.4 (0.9-6.5), P = 0.06] while TR mechanism was not [OR = 0.7 (0.3-1.8), P = 0.88]. CONCLUSION: Isolated TV surgery was associated with high mortality and morbidity, both in hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease. Published on behalf of the European Society of Cardiology. All rights reserved.
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Authors: Varius Dannenberg; Carolina Donà; Matthias Koschutnik; Max-Paul Winter; Christian Nitsche; Andreas A Kammerlander; Philipp E Bartko; Christian Hengstenberg; Julia Mascherbauer; Georg Goliasch Journal: Wien Klin Wochenschr Date: 2021-03-31 Impact factor: 1.704