scholarly journals Atrioventricular-block necessitating ventricular pacing after tricuspid valve surgery in patients with a systemic right ventricle: long term follow-up

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Nederend ◽  
M R M Jongbloed ◽  
P Kies ◽  
H W Vliegen ◽  
B J Bouma ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Valve Surgery ◽  
Av Block ◽  
Ventricular Pacing ◽  
Complex Anatomy ◽  
Av Conduction ◽  
Tricuspid Valve Surgery

Abstract Background Patients with transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are prone to systemic right ventricular (sRV) failure. Atrioventricular (AV)-conduction disturbances and tricuspid regurgitation aggravate the course of sRV dysfunction. Timely tricuspid valve (TV) surgery stabilizes sRV function. However, TV surgery is an independent risk for AV-block and ventricular pacing in non-congenital cardiothoracic surgery patients. Chronic subpulmonary ventricular pacing-induced dyssynchrony further contributes to sRV failure, potentially reducing the beneficial effects of the tricuspid valve surgery. Purpose The aim of this study is to explore the incidence, timing and functional consequences of AV-conduction block requiring ventricular pacing after TV surgery in sRV patients. Methods Consecutive adolescent and adult patients with a sRV who underwent TV surgery in the period 1989–2020 and follow-up at our tertiary care center were included in this observational cohort study. Patients who were <10 years of age at the time of operation and/or died in perioperative, in-hospital, setting were excluded from analysis (n=5). Demographic and clinical data was collected from the patient records. Results Data of 28 patients (54% female, 57% ccTGA) was analysed (Figure). The mean age at surgery was 38±13 years, 5 patients (18%) received chronic ventricular pacing preoperatively. Mean follow-up was 9.7±6.8 years, during which 7 patients (25%) died and 3 (11%) underwent ventricular assist device implantation (VAD). Two patients died awaiting VAD/HTx, one patient died awaiting CRT upgrade. Seven (25%) patients underwent a re-operation, of which 3 (11%) TV replacement, 3 (11%) VAD and 1 (4%) pulmonary valve replacement. Of the 23 patients at risk of developing AV-block, 11 (48%) developed an indication for chronic ventricular pacing, of which 6 within 24 months postoperatively (4 before hospital discharge). Of the 21 patients with a device, 7 (25%) had successful resynchronization therapy (2 before TV surgery). Patients with chronic ventricular pacing had a wider QRS-duration (mean 121 ms vs 194 ms in those without pacing, p<0.001) and 43% had a severely reduced sRV function (vs 36% in those without pacing) at latest follow-up. Conclusions Patients with a failing sRV who undergo TV surgery are prone to AV-conduction abnormalities with 48% of this group developing an indication for chronic ventricular pacing during follow-up. Pacing-induced dyssynchrony can further contribute to sRV dysfunction. Implantation of an epicardial sRV lead at the time of TV surgery for future CRT may be considered to attenuate the detrimental effects of subpulmonary ventricular pacing in this heart failure prone patient group with complex anatomy, limiting transvenous possibilities. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Outcomes of Isolated Tricuspid Valve Surgery

2020 ◽  
Vol 23 (6) ◽  
pp. E763-E769
Author(s):  
Gemma Sánchez-Espín ◽  
Jorge Rodríguez-Capitán ◽  
Juan José Otero Forero ◽  
Víctor Manuel Becerra Muñoz ◽  
Emiliano Andrés Rodríguez Caulo ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Functional Class ◽  
Valve Surgery ◽  
Perioperative Mortality ◽  
Severe Tricuspid Regurgitation ◽  
Tricuspid Valve Surgery ◽  
Long Term Mortality

Background: Isolated tricuspid valve surgery is a rarely performed procedure and traditionally is associated with a bad prognosis, although its clinical outcomes still are little known. The aim of this study was to assess the short- and long-term clinical outcomes obtained at our center after isolated tricuspid valve surgery as treatment for severe tricuspid regurgitation. Methods: This retrospective study included 71 consecutive patients with severe tricuspid regurgitation who underwent isolated tricuspid valve surgery between December 1996 and December 2017. Perioperative and long-term mortality, tricuspid valve reoperation, and functional class were analyzed after follow up. Results: Regarding surgery, 7% of patients received a De Vega annuloplasty, 14.1% an annuloplasty ring, 11.3% a mechanical prosthesis, and 67.6% a biological prosthesis. Perioperative mortality was 12.7% and no variable was shown to be predictive of this event. After a median follow up of 45.5 months, long-term mortality was 36.6%, and the multivariate analysis identified atrial fibrillation as the only predictor (Hazard Ratio 3.014, 95% confidence interval 1.06-8.566; P = 0.038). At the end of follow up, 63.6% of survivors had functional class I. Conclusions: Isolated tricuspid valve surgery was infrequent in our center. Perioperative mortality was high, as was long-term mortality. However, a high percentage of survivors were barely symptomatic after follow up.

P5569Effective regurgitant oriffice area vs vena contracta method as predictors of outcomes in severe tricuspid regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Garcia Martin ◽  
R Hinojar ◽  
A Gonzalez Gomez ◽  
M Pascual Izco ◽  
M Plaza Martin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Prognostic Value ◽  
Valve Surgery ◽  
Vena Contracta ◽  
End Point ◽  
Asymptomatic Patients ◽  
Tricuspid Valve Surgery

Abstract Background There is no gold standard echocardiographic method to evaluate tricuspid regurgitation (TR) severity. ESC guidelines recommend using a combination of several methods. The purpose of this study was to compare the prognostic value of the two most commonly used methods for the evaluation of the TR: Effective regurgitant orifice area (EROA) method and biplane vena contracta (VC) method. Methods Consecutive asymptomatic patients with significant TR (moderate to severe or severe by echocardiography) evaluated in the Heart Valve Clinic between 2015–2018 were included. TR severity was evaluated by a combination of several methods, including EROA method and biplane VC method, using EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure. Results A total of 70 patients were included (mean age was 74±8 years, 71% females). According to aetiology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). During a median follow up of 18 months [IQR: 4–28], 35% of the patients reached the combined end-point (n=16 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died). Patients with events showed a larger EROA (0.55 vs 0.40 p: 0.036) but no significance different was found in VC (8.03 vs 7.80 p: 0.27). Among both parameters, the tricuspid EROA was the only prognostic factor of the combined endpoint (EROA, HR 24.22 [1.54–380.86], p=0.023; VC, HR 1.022 [0.882–1.183]. A value of EROA of 0.42 reached the best accuracy to predicted poor outcomes (p<0.01). Conclusion Among the two most commonly used methods for the evaluation of the TR, EROA was the only method that obtained prognostic value during follow-up.

Right Mini-Thoracotomy for Aortic Plus Mitral with or without Tricuspid Valve Surgery

2020 ◽  
Author(s):  
Gloria Faerber ◽  
Sophie Tkebuchava ◽  
André Scherag ◽  
Maximilian Bley ◽  
Hristo Kirov ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Tricuspid Valve ◽  
Valve Surgery ◽  
Tricuspid Valve Surgery ◽  
Triple Valve ◽  
Mini Thoracotomy

Abstract Objectives Minimally invasive surgery is increasingly performed for isolated aortic or mitral valve procedures. However, combined minimally invasive aortic and mitral valve surgery is rare. We report our initial experience performing multiple valve procedures through a right-sided mini-thoracotomy (RMT) compared with sternotomy. Methods A total of 264 patients underwent aortic and mitral with or without tricuspid valve surgery through RMT (n = 25) or sternotomy (n = 239). Propensity score matching was used for outcome comparisons. Results Of the 264 patients, 25 (age: 72 ± 10 years; 72% male) underwent double (n = 19) and triple valve surgery (n = 6) through RMT and 239 (age: 71 ± 11 years; 54% male) underwent double (n = 176) and triple valve surgery (n = 63) through sternotomy. Sternotomy patients had more co-morbidities and preoperative risk factors (EuroSCORE II 10.25 ± 10.89 vs. RMT 3.58. ± 4.98; p < 0.001). RMT procedures were uneventful without intraoperative complications or conversions to sternotomy. After propensity score matching, surgical procedures were comparable between groups with a higher valve repair rate in RMT. Despite longer cardiopulmonary bypass times in RMT, there was no evidence for differences in 30-day mortality (RMT: n = 2 vs. sternotomy: n = 2) and there were no significant differences in other outcomes. During 5-year follow-up, reoperation was required in sternotomy patients only (n = 2). Follow-up echocardiography showed durable results after valve surgery. RMT patients showed higher survival probability compared with sternotomy, although this difference was not significant (hazard ratio = 0.33; 95% confidence interval: 0.06–1.65; p = 0.18). Conclusion Combined aortic plus mitral with or without tricuspid valve surgery can safely be performed through a RMT with a trend toward better mid-term outcomes.

scholarly journals Follow-up after tricuspid valve surgery in adult patients with systemic right ventricles

2016 ◽  
Vol 50 (3) ◽  
pp. 456-463 ◽  
Author(s):  
David R. Koolbergen ◽  
Yunus Ahmed ◽  
Berto J. Bouma ◽  
Roderick W.C. Scherptong ◽  
Eline F. Bruggemans ◽  
...  
Keyword(s):  
Tricuspid Valve ◽  
Valve Surgery ◽  
Adult Patients ◽  
Tricuspid Valve Surgery

Abstract 12871: Comparison of Risk Scores at Predicting Mortality and Morbidities After Isolated Tricuspid Valve Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Kevser Akyuz ◽  
Alejandro Duran Crane ◽  
Samantha Xu ◽  
Bo Xu ◽  
...  
Keyword(s):  
Confidence Intervals ◽  
Tricuspid Valve ◽  
Cleveland Clinic ◽  
Valve Surgery ◽  
Risk Scores ◽  
Risk Models ◽  
Tricuspid Valve Surgery ◽  
Operative Complications ◽  
Post Operative Complications

Background: Risk models play important roles in stratification and decision-making towards cardiac surgery. Isolated tricuspid valve surgery (TVR) is a high risk but increasingly performed operation, however the performance of surgical risk models, including the recently developed Society of Thoracic Surgeon’s (STS) TVR score, have not been externally evaluated in these patients. We compared the prognostic utility of contemporary risk scores for isolated TVR. Methods: Consecutive patients undergoing isolated TVR at Cleveland Clinic during 2004-2018 were evaluated. EuroSCORE II and STS-TVR score were retrospectively calculated, and their performance for predicting 30-day mortality, post-operative complications and mortality during follow-up were assessed. Results: Amongst 207 patients studied, mean age was 54.1±17.9 years, 116 (56.0%) were female, 92 (44.4%) had secondary tricuspid regurgitation, and 151 (72.9%) had surgical repair. Mean EuroSCORE II and STS-TVR scores were 6.3±6.6% and 5.5±6.2% respectively. Operative mortality occurred in 10 (4.9%). C-statistics (95% confidence intervals) for 30-day mortality were 0.83 (0.74-0.93) for EuroSCORE II and 0.60 (0.45-0.75) for STS-TVR score (Table), and observed/expected ratios were 0.78 and 0.89 respectively. EuroSCORE II also had higher c-statistics for composite and most post-operative complications. In univariable Cox regression for mortality during follow-up, hazards ratios (95% confidence intervals) were 1.08 (1.05-1.11) for EuroSCORE II and 1.06 (1.02-1.11) for STS-TVR score. Conclusion: EuroSCORE II was superior to STS-TVR score at predicting adverse outcomes after isolated TVR. Although risk scores traditionally under-estimated 30-day mortality after isolated TVR, our excellent surgical results meant that calibration of both scores were satisfactory for our cohort, and provides a benchmark for future studies of isolated surgical and transcatheter tricuspid valve procedures.

Tricuspid valve surgery at five year follow up - which determinants of outcome remain?

2011 ◽  
Vol 59 (S 01) ◽  
Author(s):  
F Hahnel ◽  
M Wilbring ◽  
H Gulbins ◽  
H Reichenspurner
Keyword(s):  
Tricuspid Valve ◽  
Valve Surgery ◽  
Tricuspid Valve Surgery

scholarly journals Minimally Invasive Isolated Tricuspid Valve Repair: the Trend for Redo Tricuspid Valve Surgery

2021 ◽  
Author(s):  
Xiaoyi Dai ◽  
Peng Teng ◽  
Sihan Miao ◽  
Wei Si ◽  
Qi Zheng ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Nyha Class ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Tricuspid Valve Surgery ◽  
The Mean

Abstract Background: Tricuspid regurgitation after left-sided valve surgery was associated with terrible outcomes and high perioperative mortality for redo surgical treatment. In current years, minimally invasive redo isolated tricuspid valve repair is increasingly performed in our institution to address tricuspid regurgitation. Methods: Thirty-seven consecutive patients with previous left-sided valve surgery underwent minimally invasive redo isolated tricuspid valve repair in our institution between November 2017 and December 2020. Twenty-nine patients(78.4%) were women and the mean age of patients was 58.4±8.5 years. Follow-up was 100% complete with a mean follow-up time of 16.8±9.4 months.Results: Both the in-hospital and 30-day mortalities were 2.7%. The overall NYHA class had improved significantly during the follow-up(p＜0.001). The grade of TR had decreased before discharge(p＜0.001) and during the follow-up(p＜0.001) compared with the preoperative level although severe TR was recurrent in one patient.Conclusions: Minimally invasive redo isolated tricuspid valve repair has remarkable early and midterm outcomes, may be the preferred surgical option to address tricuspid regurgitation after previous left-sided valve surgery when it is feasible.

scholarly journals Simplified Minimally Invasive Beating Heart Technique for Redo Isolated Tricuspid Valve Surgery

2020 ◽  
Author(s):  
Shuyang Lu ◽  
Kai Song ◽  
Wangchao Yao ◽  
Limin Xia ◽  
Lili Dong ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Tricuspid Valve ◽  
Beating Heart ◽  
Valve Surgery ◽  
Midterm Results ◽  
Tricuspid Valve Surgery ◽  
Cardiac Operations

Abstract BackgroundRedo isolated tricuspid valve surgery has been associated with a high morbidity and mortality, and its optimal timing of surgical intervention remains controversial. Hence, we reviewed our early and midterm results with a simplified minimally invasive beating heart technique for isolated redo tricuspid valve surgery in patients at high risk.MethodsBetween June 2016 and August 2017, a total of 14 consecutive patients underwent isolated tricuspid valve operations after previous cardiac operations with minimally invasive beating heart technique through a right lateral thoracotomy in our center. Mean patient age was 54.0 ± 8.3 years, and 9 patients (64.3%) were women. Mean preoperative EuroSCORE was 8.1 ± 1.3 (6 to 11). Previous cardiac operations included 6 patients (42.9%) with mitral valve replacement, 1 patient (7.1%) with mitral valve replacement and tricuspid valve repair, 1 patient (7.1%) with tricuspid valve replacement, 5 patients (35.7%) with mitral valve and aortic valve replacement, and 1 patient (7.1%) with Ebstein repair. Midterm follow-up was complete for 12 patients (85.7%).ResultsBoth in-hospital and thirty-day mortalities were 0%. Tricuspid valve replacement with bioprosthesis was performed in 12 patients (85.7%), and the remaining 2 patients (14.3%) underwent tricuspid repair (annuloplasty and leaflets reconstruction). Mean cardiopulmonary bypass time was 55.6 ± 10.7 minutes. Overall in-hospital duration and intensive care unit (ICU) time were 11.6 ± 8.8 days, 3.9 ± 2.8 days, respectively. Postoperative complications included 2 patients (1.4%) with prolonged ventilation, and 2 patients (1.4%) with acute kidney injury. There were no postoperative cerebrovascular accidents, myocardial infarctions, reoperations for bleeding, or deep wound infections. All patients were discharged uneventful. Except 2 patients lost follow-up, there were no adverse cardiovascular events and deaths occurred in other patients.ConclusionsSimplified minimally invasive beating heart technique for redo tricuspid valve surgery is both feasible and safe, and the early and midterm results are excellent.

Sign in / Sign up

Export Citation Format

Share Document