Comparative early outcomes of tricuspid Valve repair versus replacement for secondary tricuspid regurgitation

BackgroundComparative outcome data on tricuspid valve repair (TVr) versus tricuspid valve replacement (TVR) for severe secondary tricuspid regurgitation (TR) are limited.MethodsWe used a national inpatient sample to assess in-hospital morbidity and mortality, length of stay and cost in patients with severe secondary TR undergoing isolated TVr versus TVR.ResultsA total of 1364 patients (national estimate=6757) underwent isolated tricuspid valve surgery during the study period, of whom 569 (41.7%) had TVr and 795 (58.3%) had TVR. There was no difference in the prevalence of major morbidities between the two groups, except for liver disease and hepatic cirrhosis, which were more common in the TVR group. Before propensity matching, in-hospital mortality was similar between patients who underwent isolated TVr and TVR (8.1% vs 10.8%, p=0.093), but the incidence of postoperative morbidities differed: TVR was associated with higher rates of permanent pacemaker implantation and blood transfusion, while TVr was associated with more acute kidney injury. After rigorous propensity score matching, TVR was associated with significantly higher rates of in-hospital death (12% vs 6.9%, p=0.009) and permanent pacemaker implantation (33.7% vs 11.2%, p<0.001). Postoperative morbidities and length of stay, however, were not different between the two groups. Nonetheless, cost of hospitalisation was 16% higher in the TVr group.ConclusionsIn patients undergoing isolated surgery for secondary TR, TVR is associated with higher in-hospital mortality and need for permanent pacemaker compared with TVr. Further studies are needed to understand the impact of the type of surgery on the short-term and long-term mortality in this complex undertreated population.

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First percutaneous Micra leadless pacemaker implantation and tricuspid valve repair with MitraClip NT for lead-associated severe tricuspid regurgitation

EuroIntervention ◽

10.4244/eij-d-17-00023 ◽

2017 ◽

Vol 12 (15) ◽

pp. e1845-e1848 ◽

Cited By ~ 9

Author(s):

Gilbert Tang ◽

Ryan Kaple ◽

Martin Cohen ◽

Tanya Dutta ◽

Cenap Undemir ◽

...

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Pacemaker Implantation ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Severe Tricuspid Regurgitation ◽

Leadless Pacemaker

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CT19P TRICUSPID VALVE REPAIR IN ?TORRENTIAL TRICUSPID REGURGITATION? FOLLOWING PERMANENT PACEMAKER LEAD EXTRACTION ? A CASE REPORT

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2007.04115_19.x ◽

2007 ◽

Vol 77 (s1) ◽

pp. A12-A12

Author(s):

D. Mehrotra ◽

A. Miller ◽

H. McAlister ◽

N. K. Kejriwal

Keyword(s):

Case Report ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Permanent Pacemaker ◽

Lead Extraction ◽

Tricuspid Valve Repair ◽

Pacemaker Lead ◽

Valve Repair

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Faculty Opinions recommendation of Long-Term Outcomes of the FORMA Transcatheter Tricuspid Valve Repair System for the Treatment of Severe Tricuspid Regurgitation: Insights From the First-in-Human Experience.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736343783.793580323 ◽

2020 ◽

Author(s):

Michele De Bonis ◽

Benedetto Del Forno

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Human Experience ◽

Tricuspid Valve Repair ◽

Repair System ◽

Valve Repair ◽

Long Term Outcomes ◽

Severe Tricuspid Regurgitation

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Tricuspid Valve Repair for the Poor Right Ventricle: Tricuspid Valve Repair in Patients with Mild-to-Moderate Tricuspid Regurgitation Undergoing Mitral Valve Repair Improves In-Hospital Outcome

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0034-1399783 ◽

2015 ◽

Vol 65 (08) ◽

pp. 612-616 ◽

Cited By ~ 2

Author(s):

Michele Genoni ◽

Kirk Graves ◽

Dragan Odavic ◽

Helen Löblein ◽

Achim Häussler ◽

...

Keyword(s):

United States ◽

Mitral Valve ◽

Blood Transfusion ◽

Right Ventricle ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Operation Time ◽

Tricuspid Valve Repair ◽

Cell Saver ◽

Valve Repair

Background Tricuspid regurgitation (TR) in patients undergoing surgery for mitral valve (MV) increases morbidity and mortality, especially in case of a poor right ventricle. Does repair of mild-to-moderate insufficiency of the tricuspid valve (TV) in patients undergoing MV surgery lead to a benefit in early postoperative outcome? Methods A total of 22 patients with mild-to-moderate TR underwent MV repair and concomitant TV repair with Tri-Ad (Medtronic ATS Medical Inc., Minneapolis, Minnesota, United States) and Edwards Cosgrove (Edwards Lifesciences Irvine, California, United States) rings. The severity of TR was assessed echocardiographically by using color-Doppler flow images. The tricuspid annular plane systolic excursion (TAPSE) was under 1.7 cm. Additional procedures included coronary artery bypass (n = 9) and maze procedure (n = 15). The following parameters were compared: postoperative and peak dose of noradrenaline (NA), pre/postoperative systolic pulmonary pressure (sPAP), extubation time, operation time, cross-clamp time, cardiopulmonary bypass (CPB) time, pre/postoperative ejection fraction (EF), intensive care unit (ICU)-stay, hospital stay, cell saver blood transfusion, intra/postoperative blood transfusion, and postoperative TR. Results The mean age was 67 ± 14.8 years, 45% were male. Mean EF was 47 ± 16.2%, postoperative 52 ± 12.4%. sPAP was 46 ± 20.1 mm Hg preoperatively, sPAP was 40.6 ± 9.4 mm Hg postoperatively, NA postoperatively was 12 ± 10 μg/min, NA peak was 18 ± 11 μg/min, operation time was 275 ± 92 minutes, CPB was 145 ± 49 minutes, ICU stay was 2.4 ± 2.4 days, hospital stay was 10.8 ± 3.5 days, cell saver blood transfusion was 736 ± 346 mL, intraoperative transfusions were 2.5 ± 1.6. Two patients needed postoperative transfusions. A total of 19 patients were extubated at the 1st postoperative day, 2 patients at the 2nd day, and 1 at the 4th postoperative day. Two patients required a pacemaker. No reintubation, no in-hospital mortality, and one reoperation because of bleeding complications. Conclusion Correction of mild-to-moderate TR at the time of MV repair does maintain TV function and avoid right ventricular dysfunction in the early postoperative period improving the clinical outcome.

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P1585Long-term tricuspid regurgitation progression in patients undergoing combined mitral valve replacement surgery and tricuspid valve repair

European Heart Journal ◽

10.1093/eurheartj/ehy565.p1585 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

O Itzhaki Ben Zadok ◽

R Sharony ◽

M Vaturi ◽

Y Shapira ◽

T Bental ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Replacement Surgery ◽

Valve Replacement Surgery

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Assessment of the effects of cardiac rhythm device implantation on right sided heart function and tricuspid valve

QJM ◽

10.1093/qjmed/hcab090.008 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ahmed Mohamed Abd Elaziz ◽

Ahmed Yehia Ramadan ◽

Haitham Abd Elfatah Badran ◽

Saied Abd Elhafiz Khalid

Keyword(s):

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Cardiac Rhythm ◽

Heart Function ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

P Value ◽

Device Implantation ◽

Echocardiographic Study ◽

One Year

Abstract Objective To assess the effects of trans-tricuspid placement of permanent pacemaker (PPM), on the right-sided heart function and tricuspid valve function. Background Over the last decade there has been a significant increase in the number of cardiac device implantation as permanent pacemakers (PPM) worldwide in patients with cardiac rhythm disorders. Tricuspid regurgitation (TR) due to the endocardial lead is a known complication of this procedure, however the incidence of new or worsening TR had not been well studied. Patients and Methods We reviewed patients who underwent permanent pacemaker implantation in our cardiology department in Ain Shams University. Patients who had pacemaker implantation less than one year ago, had severe tricuspid regurgitation before implantation or had previous tricuspid valve repair were excluded. A total of one hundred patients with an echocardiographic study before and another echocardiographic study at least one year after device implantation were included in our study. TR severity was graded as (0 none/trace, 1 mild, 2 moderate, 3 severe). Results Of the 100 patients (Mean age: 53.10 ± 16.04, 50% of patients were males) 65 had DDD and 35 had VVI. Before implantation 25 patient had trace TR (grade 0) vs. 6 patients after, 75 patients had mild TR (grade 1) vs. 82 after, with no patient had moderate TR (grade 2) vs. 12 patients after. TR worsened by one grade in 25 patients, (16 patients from grade 0 to grade 1 and 9 patients from grade 1 to grade 2) and by 2 grades in 3 patients (from grade 0 to grade 2), Pvalue < 0.01. TR jet area size (Mean ± SD: 2.80 ± 0.77 before vs. 4.15 ± 1.29 after, P-value < 0.01). Also, 99 patients had normal RV size and one had dilated RV before implantation vs. 95 patient had normal RV and 5 had dilated RV (p-value= 0.097). RV size, LVEF (Mean ± SD: 56.41% ± 7.52 before vs. 55.77% ± 8.00 after), RV function by TASPE (Mean ± SD: 19.15 ± 1.00 before vs. 18.96 ± 0.96 after), RVSP (Mean ± SD: 29.48mmHg ± 5.54 before vs. 29.81 ± 5.09 after) and diastolic function by E/A ratio (Mean ± SD: 1.60 ± 0.39 before vs. 1.57 ± 0.38 after implantation) did not show significant change. Conclusion Permanent pacemaker (PPM) implantation is associated with worsening of tricuspid regurgitation. Echocardiography plays an important role in assessing and grading this condition. Further studies are needed in order to illustrate the effects of these finding on patients outcomes.

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Abstract 266: Incidence, Predictors and Outcomes of Permanent Pacemaker Implantation Among Patients With Bradyarrhythmias Following Cardiac Surgery: Insights From the National Inpatient Sample Database

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.266 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Karol Quelal ◽

Olakanmi Olagoke ◽

Jose Baez

Keyword(s):

Cardiac Surgery ◽

Valve Replacement ◽

Heart Surgery ◽

Artery Bypass ◽

Open Heart Surgery ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Hospital Death ◽

National Inpatient Sample ◽

Permanent Pacemaker Implantation

Introduction: Significant atrioventricular blocks and bradyarrhythmias are known complications of open-heart surgery. These are frequently transient, however, some patients go on to need a permanent pacemaker (PP). We sought to describe the incidence, predictors, and outcomes of PP implantation among patients admitted for cardiac surgery who develop bradyarrhythmias. Methods: We queried the National Inpatient Sample (NIS) database from 2010 to 2014 for adults admitted for surgical valve replacement, valvuloplasty or coronary artery bypass grafting (CABG) who had bradyarrhythmias during the admission using the appropriate ICD codes. We identified patients who had permanent pacemaker implantation documented during the admission. Categorical and continuous variables were compared using the chi-square and student's t-test. Predictors of PP implantation and in-hospital mortality were evaluated by logistic regression. Results: Of the 1402930 patients who underwent cardiac surgery, 94748 patients had bradyarrhythmias defined as sinoatrial node dysfunction (SND) and/or atrioventricular block (AVB) during hospitalization. The primary procedure was identified as valve replacement in 50.3% (47615 of 94748), CABG in 29.9% (27622 of 94748) and valvuloplasty in 8.7% (8248 of 94748). SND was found in 29.9% (28372 of 94748) and AVB in 76% (72017 of 94748). Permanent pacemaker implantation was done in 39.3% (37246 of 94748). Valve replacement was the most common surgery associated with PP implantation [58% (21682 of 37246) compared to 21.5% in CABG (8007 of 37246) and 7.7% in valvuloplasty (2882 of 37246), p < 0.001). Female sex aOR 1.36 (95% CI 1.31 - 1.40), young age 18 - 44 years aOR 1.36 (95% CI 1.24 - 1.49), Asiatic and Hispanic origin aOR 1.36 (95% CI 1.23 - 1.51), aOR 1.25 (95% CI 1.17 - 1.34) respectively, diabetes mellitus with chronic complications aOR 1.16 (95% CI 1.09 - 1.24), drug abuse aOR 1.38 (95% CI 1.21 - 1.55) were associated with higher odds of pacemaker implantation. African American origin aOR 0.79 (95CI 0.74 - 0.85), AIDS aOR 0.33 (95% CI 0.17 - 0.67), south hospital region aOR 0.89 (95% CI 0.85 - 0.93), no-charge admissions aOR 0.66 (95% CI 0.49 - 0.89) were associated with a lower odds of PPM implantation. Death during hospitalization was found in 3% of the patients. After multivariable regression, PP implantation was associated with a lower likelihood of in-hospital death aOR 0.45 (95% CI 0.41 - 0.50). Conclusion: Approximately one-third of the patients hospitalized for cardiac surgery related to AVB and/or SND were implanted a permanent pacemaker. Factors like age, sex, race and comorbidities determine the likelihood of this procedure that has a significant impact on mortality. Having a better insight into these predictors would allow a better triage of patients who would benefit from its implantation.

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