Sri Harsha Patlolla1, Hartzell V Schaff2, Kevin L Greason3, Alberto Pochettino3, Richard C Daly3, Robert L Frye4, Rick A Nishimura4, Joseph A Dearani3. 1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester. 2. Department of Cardiovascular Surgery, Mayo Clinic, Rochester. Electronic address: schaff@mayo.edu. 3. Department of Cardiovascular Surgery, Mayo Clinic, Rochester. 4. Department of Cardiovascular Medicine, Mayo Clinic, Rochester.
Abstract
BACKGROUND: There are limited data on the impact of isolated tricuspid valve (TV) surgery on recovery of right ventricular (RV) function and RV reverse remodeling. METHODS: Among 223 patients who had isolated TV procedures between 2001 and 2017, 60 (27%) underwent TV repair and 163 (73%) received TV replacement. Indication for surgery was functional TR in 64%, lead induced in 18%, and primary leaflet dysfunction in 18%. RV reverse remodeling was assessed by echocardiography at a median of 11.3 months (IQR 5.9-13.5) post-dismissal. RESULTS: Mean age was 67.3±13.7 years, and 57% were female. Overall 30-day mortality was 2.7%. After a median follow-up period of 9.5 years (IQR 3.6-12.9), adjusted Cox regression analysis revealed comparable survival for TV repair and replacement and identified older age, and presence of RV dysfunction (HR 1.84, 95% CI 1.14-2.98; P=0.01) as independent predictors of poor survival. Patients who exhibited RV reverse remodeling within 18 months postoperatively had significantly improved survival compared to those who did not (Log-Rank P=0.005), and reverse remodeling was independently associated with improved survival (HR 0.42, 95% CI 0.24-0.74; P=0.003). Lower preoperative right atrial pressure (OR 0.83, 95% CI 0.73-0.94; P=0.004) was predictive of early RV reverse remodeling. CONCLUSIONS: Isolated TV surgery can be performed with acceptable outcomes (early mortality 2.7%), and overall survival is best in patients who receive the operation before developing RV systolic dysfunction. Adjusted survival was similar for patients undergoing TV repair or replacement. Early reverse remodeling of RV after surgery is associated with survival benefit.
BACKGROUND: There are limited data on the impact of isolated tricuspid valve (TV) surgery on recovery of right ventricular (RV) function and RV reverse remodeling. METHODS: Among 223 patients who had isolated TV procedures between 2001 and 2017, 60 (27%) underwent TV repair and 163 (73%) received TV replacement. Indication for surgery was functional TR in 64%, lead induced in 18%, and primary leaflet dysfunction in 18%. RV reverse remodeling was assessed by echocardiography at a median of 11.3 months (IQR 5.9-13.5) post-dismissal. RESULTS: Mean age was 67.3±13.7 years, and 57% were female. Overall 30-day mortality was 2.7%. After a median follow-up period of 9.5 years (IQR 3.6-12.9), adjusted Cox regression analysis revealed comparable survival for TV repair and replacement and identified older age, and presence of RV dysfunction (HR 1.84, 95% CI 1.14-2.98; P=0.01) as independent predictors of poor survival. Patients who exhibited RV reverse remodeling within 18 months postoperatively had significantly improved survival compared to those who did not (Log-Rank P=0.005), and reverse remodeling was independently associated with improved survival (HR 0.42, 95% CI 0.24-0.74; P=0.003). Lower preoperative right atrial pressure (OR 0.83, 95% CI 0.73-0.94; P=0.004) was predictive of early RV reverse remodeling. CONCLUSIONS: Isolated TV surgery can be performed with acceptable outcomes (early mortality 2.7%), and overall survival is best in patients who receive the operation before developing RV systolic dysfunction. Adjusted survival was similar for patients undergoing TV repair or replacement. Early reverse remodeling of RV after surgery is associated with survival benefit.