DOI: 10.1161/circulationaha.109.849448. Determinants of Surgical Outcome in Patients With Isolated Tricuspid Regurgitation

Determinants of Surgical Outcome in Patients With Isolated Tricuspid Regurgitation

10.1161/circulationaha.109.849448

Crossref journal-article

Ovid Technologies (Wolters Kluwer Health)

Circulation (276)

Abstract

Background— We sought to identify preoperative predictors of clinical outcomes after surgery in patients with severe tricuspid regurgitation. Methods and Results— We prospectively enrolled 61 consecutive patients (54 women, aged 57±9 years) with isolated severe tricuspid regurgitation undergoing corrective surgery. Twenty-one patients (34%) were in New York Heart Association functional class II, 35 (57%) in class III, and 5 (9%) in class IV. Fifty-seven patients (93%) had previous history of left-sided valve surgery. Preoperative echocardiography revealed pulmonary artery systolic pressure of 41.5±8.7 mm Hg, right ventricular (RV) end-diastolic area of 35.1±9.0 cm 2 , and RV fractional area change of 41.3±8.4%. The median follow-up duration after surgery was 32 months (range, 12 to 70). Six of the 61 patients died before discharge; thus, operative mortality was 10%. Three of the 55 patients who survived surgery died during follow-up, and 6 patients required readmission because of cardiovascular problems. Thus, 46 patients (75%) remained event free at the end of follow-up. In the 54 patients who underwent 6-month clinical and echocardiographic follow-up, RV end-diastolic area decreased by 29%, with a corresponding 26% reduction in RV fractional area change. Thirty-three patients (61%) showed improved functional capacity after surgery. On multivariable Cox regression analysis, preoperative hemoglobin level ( P <0.001) and RV end-systolic area ( P <0.001) emerged as independent determinants of clinical outcomes. On receiver operating characteristic curve analysis, we found that RV end-systolic area <20 cm 2 predicted event-free survival with a sensitivity of 73% and a specificity of 67%, and a hemoglobin level >11.3 g/dL predicted event-free survival with a sensitivity of 73% and a specificity of 83%. Conclusions— Timely correction of severe tricuspid regurgitation carries an acceptable risk and improves functional capacity. Surgery should be considered before the development of advanced RV systolic dysfunction and before the development of anemia.

Bibliography

Kim, Y.-J., Kwon, D.-A., Kim, H.-K., Park, J.-S., Hahn, S., Kim, K.-H., Kim, K.-B., Sohn, D.-W., Ahn, H., Oh, B.-H., & Park, Y.-B. (2009). Determinants of Surgical Outcome in Patients With Isolated Tricuspid Regurgitation. Circulation, 120(17), 1672â1678.

Authors 11

Yong-Jin Kim (first)
Dong-A Kwon (additional)
Hyung-Kwan Kim (additional)
Jin-Shik Park (additional)
Seokyung Hahn (additional)
Kyung-Hwan Kim (additional)
Ki-Bong Kim (additional)
Dae-Won Sohn (additional)
Hyuk Ahn (additional)
Byung-Hee Oh (additional)
Young-Bae Park (additional)

References 19 Referenced 248

10.1161/circulationaha.106.176857
10.1161/CIRCULATIONAHA.104.524496
10.1016/j.jacc.2003.09.036
10.1016/j.amjcard.2006.03.047
10.1016/S1010-7940(01)00786-2
Staab ME, Nishimura RA, Dearani JA. Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients. J Heart Valve Dis. 1999; 8: 567–574. / J Heart Valve Dis (1999)
10.1016/j.echo.2005.10.005
10.1016/j.ahj.2007.11.010
10.1136/hrt.66.4.295
10.1016/S0003-4975(03)00028-6
10.1067/mhj.2002.123575
Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis. 1992; 1: 80–86. / J Heart Valve Dis (1992)
10.1093/cvr/9.4.447
10.1016/0002-9149(79)90446-6
10.1136/hrt.70.4.357
10.1161/circulationaha.104.512988
10.1161/circulationaha.105.577577
King RM, Schaff HV, Danielson GK, Gersh BJ, Orszulak TA, Piehler JM, Puga FJ, Pluth JR. Surgery for tricuspid regurgitation late after mitral valve replacement. Circulation. 1984; 70 (pt 2): I193–I197. / Circulation (1984)
10.1161/circulationaha.106.634436

Dates

Type	When
Created	15 years, 10 months ago (Oct. 12, 2009, 9:54 p.m.)
Deposited	1 year, 3 months ago (May 13, 2024, 2:16 a.m.)
Indexed	4 days, 6 hours ago (Sept. 3, 2025, 7:02 a.m.)
Issued	15 years, 10 months ago (Oct. 27, 2009)
Published	15 years, 10 months ago (Oct. 27, 2009)
Published Print	15 years, 10 months ago (Oct. 27, 2009)

Funders 0

None

BibTeX

@article{Kim_2009, title={Determinants of Surgical Outcome in Patients With Isolated Tricuspid Regurgitation}, volume={120}, ISSN={1524-4539}, url={http://dx.doi.org/10.1161/circulationaha.109.849448}, DOI={10.1161/circulationaha.109.849448}, number={17}, journal={Circulation}, publisher={Ovid Technologies (Wolters Kluwer Health)}, author={Kim, Yong-Jin and Kwon, Dong-A and Kim, Hyung-Kwan and Park, Jin-Shik and Hahn, Seokyung and Kim, Kyung-Hwan and Kim, Ki-Bong and Sohn, Dae-Won and Ahn, Hyuk and Oh, Byung-Hee and Park, Young-Bae}, year={2009}, month=oct, pages={1672–1678} }

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  "abstract": "<jats:p>\n            <jats:bold>\n              <jats:italic>Background\u2014</jats:italic>\n            </jats:bold>\n            We sought to identify preoperative predictors of clinical outcomes after surgery in patients with severe tricuspid regurgitation.\n          </jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods and Results\u2014</jats:italic>\n            </jats:bold>\n            We prospectively enrolled 61 consecutive patients (54 women, aged 57\u00b19 years) with isolated severe tricuspid regurgitation undergoing corrective surgery. Twenty-one patients (34%) were in New York Heart Association functional class II, 35 (57%) in class III, and 5 (9%) in class IV. Fifty-seven patients (93%) had previous history of left-sided valve surgery. Preoperative echocardiography revealed pulmonary artery systolic pressure of 41.5\u00b18.7 mm Hg, right ventricular (RV) end-diastolic area of 35.1\u00b19.0 cm\n            <jats:sup>2</jats:sup>\n            , and RV fractional area change of 41.3\u00b18.4%. The median follow-up duration after surgery was 32 months (range, 12 to 70). Six of the 61 patients died before discharge; thus, operative mortality was 10%. Three of the 55 patients who survived surgery died during follow-up, and 6 patients required readmission because of cardiovascular problems. Thus, 46 patients (75%) remained event free at the end of follow-up. In the 54 patients who underwent 6-month clinical and echocardiographic follow-up, RV end-diastolic area decreased by 29%, with a corresponding 26% reduction in RV fractional area change. Thirty-three patients (61%) showed improved functional capacity after surgery. On multivariable Cox regression analysis, preoperative hemoglobin level (\n            <jats:italic>P</jats:italic>\n            &lt;0.001) and RV end-systolic area (\n            <jats:italic>P</jats:italic>\n            &lt;0.001) emerged as independent determinants of clinical outcomes. On receiver operating characteristic curve analysis, we found that RV end-systolic area &lt;20 cm\n            <jats:sup>2</jats:sup>\n            predicted event-free survival with a sensitivity of 73% and a specificity of 67%, and a hemoglobin level &gt;11.3 g/dL predicted event-free survival with a sensitivity of 73% and a specificity of 83%.\n          </jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusions\u2014</jats:italic>\n            </jats:bold>\n            Timely correction of severe tricuspid regurgitation carries an acceptable risk and improves functional capacity. Surgery should be considered before the development of advanced RV systolic dysfunction and before the development of anemia.\n          </jats:p>",
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