scholarly journals Determinants of Morbidity and Mortality Associated With Isolated Tricuspid Valve Surgery

2021 ◽  
Author(s):  
Akram Kawsara ◽  
Fahad Alqahtani ◽  
Vuyisile T. Nkomo ◽  
Mackram F. Eleid ◽  
Sorin V. Pislaru ◽  
...  
Keyword(s):  
Heart Failure ◽  
Logistic Regression ◽  
Liver Disease ◽  
Tricuspid Valve ◽  
Valve Surgery ◽  
Advanced Liver Disease ◽  
The Poor ◽  
Tricuspid Valve Surgery ◽  
Poor Outcomes ◽  
Late Referral

Background Whether the poor outcomes of isolated tricuspid valve surgery are related to the operation itself or to certain patient characteristics including late referral is unknown. Methods and Results Adult patients who underwent isolated tricuspid valve surgery were identified in the Nationwide Readmissions Database (2016–2017). Patients who had redo tricuspid valve surgery, endocarditis, or congenital heart disease were excluded. Multivariable logistic regression was performed to identify contributors to postoperative mortality. A total of 1513 patients were included (mean age 55.7±16.6 years, 49.6% women). Surrogates of late referral were frequent: 41% of patients were admitted with decompensated heart failure, 44.3% had a nonelective surgery status, 16.8% had advanced liver disease, and 31% had an unplanned hospitalization in the prior 90 days. The operation was performed on day 0 to 1 of the hospitalization in only 50% of patients, and beyond day 10 in 22% of patients. In‐hospital mortality occurred in 8.7% of patients. Median length of stay was 14 days (7–35 days), and median cost was $87 223 ($43 122–$200 872). In multivariable logistic regression analysis, surrogates for late referrals (acute heart failure decompensation, nonelective surgery status, or advanced liver disease) were the strongest predictors of in‐hospital mortality (odds ratio [OR], 4.75; 95% CI, 2.74–8.25 [ P <0.001]). This was also consistent in a second model incorporating unplanned hospitalizations in the 90 days before surgery as a surrogate for late referral (OR, 5.50; 95% CI, 2.28–10.71 [ P <0.001]). Conclusions The poor outcomes of isolated tricuspid valve surgery may be largely explained by the late referral for intervention. Studies are needed to determine the role of early intervention for severe isolated tricuspid regurgitation.

P5566Prognostic value of quantitative assessment of tricuspid regurgitation. Correlation between echocardiography and cardiac magnetic resonance

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Hinojar Baydes ◽  
A Garcia Martin ◽  
A Gonzalez-Gomez ◽  
G Alonso-Salinas ◽  
M Plaza-Martin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Valve Surgery ◽  
Regurgitant Fraction ◽  
End Point ◽  
Tricuspid Valve Surgery ◽  
Poor Outcomes

Abstract Background Significant tricuspid regurgitation (TR) is related to poor prognosis independently of the etiology. TR severity and right ventricular (RV) size and function are determinant in the evaluation of patients with RT and are independently related to outcomes. While TR severity is commonly evaluated with echocardiography (echo), cardiac magnetic resonance (CMR) is the gold standard to study the RV. The association between CMR and echocardiographic measures of quantitative TR is unknown. Purpose Our aim was to evaluate the association between the most commonly used methods in both techniques: biplane vena contracta (VC) and effective regurgitant orifice (ERO) parameters evaluated by echo and TR volume (TRV) and TR regurgitant fraction (TRF) by CMR; secondly we aimed to evaluate the prognostic value of each parameter. Methods Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 with a contemporaneous echo and CMR were included. TR severity was evaluated by VC and ERO method, using EPIQ system and by VRF and TRF using a 1.5 Tesla CMR Philips scanner. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure. Results A total of 36 patients were included (mean age was 72±7 years, 72% females, 94% functional TR). Both VC and ERO showed moderate to strong and significant correlations with VRF and TRF (table). During a median follow up of 20 months [IQR: 10–29], 38% of the patients reached the combined end point (n=7 developed right heart failure, n=11 underwent tricuspid valve surgery, and n=2 died). Patients with events showed a larger ERO and higher VRF and TRF (p<0.01 for all) and a tendency to larger VC (p=0.06). PISA, VRF and TRF were prognostic factors of the combined endpoint (PISA per 0.1 cm2, HR: 282 [3.9–20362], p=0.01; VC per 1 mm, HR 1.27 [0.98–1.64] p=0.06; VRF per 1ml: HR: 1.02 [1.005–1.025], p=0.003; FRT per 1%, HR: 219.5 [4.8–9897], p=0.06). A value of PISA of 0.42, of VRF of 46 ml and FRV of 43% reached the best accuracy to predicted poor outcomes (p<0.01 for all). Table 1. Bivariate correlations ERO VC Regurgitant volume by CMR R=0.57, p=0.004 R=0.55, p=0.003 Regurgitant fraction by CMR R=0.61, p<0.001 R=0.56, p=0.01 Conclusion Validated echocardiographic parameters of TR are significantly correlated with quantitative measures by CMR. PISA by echo, and VRF and FRV by CMR are predictive of impaired prognosis. Further studies confirming our CMR cut-off values of poor outcomes are needed for clinical implementation.

Right Heart Failure and Patient Selection for Isolated Tricuspid Valve Surgery

2021 ◽  
Author(s):  
Haytham Elgharably ◽  
Ahmed Ibrahim ◽  
Bradley Rosinski ◽  
Lucy Thuita ◽  
Eugene H. Blackstone ◽  
...  
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Patient Selection ◽  
Right Heart Failure ◽  
Valve Surgery ◽  
Right Heart ◽  
Tricuspid Valve Surgery ◽  
Selection For

scholarly journals P288 Prognostic role of hemoglobin levels in patients with severe tricuspid regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Garcia Martin ◽  
R Hinojar ◽  
A Gonzalez Gomez ◽  
M Plaza Martin ◽  
M Pascual Izco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Valve Surgery ◽  
Therapeutic Options ◽  
Severe Tricuspid Regurgitation ◽  
End Point ◽  
Tricuspid Valve Surgery

Abstract Background Patients with severe tricuspid regurgitation (TR) frequently develop heart failure (HF) and their surgical therapeutic options are limited because of very high or prohibitive risk. According to the 2016 ESC guidelines for HF, anaemia and iron deficiency are associated with worse prognosis and intravenous iron therapy should be considered in symptomatic patients with HF reduced ejection fraction (HFrEF) in order to alleviate symptoms, improve exercise capacity and quality of life. The effect of treating iron deficiency in HF preserved ejection fraction (HFpEF) is unknown. The purpose of this study was to analyze the correlation between levels of hemoglobin (Hb) and the prognosis in patients with severe TR and preserve EF. Methods Consecutive patients with significant TR (moderate to severe or severe by echocardiography) evaluated in the Heart Valve Clinic between 2015-2018 were included. 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). Mean left ventricular ejection fraction was 56,5% ±6,7%. During a median follow up of 18 months [IQR: 4-28], 35% of the patients reached the combined end-point (n = 16 developed right HF, n = 17 underwent tricuspid valve surgery, and n = 3 died). Patients with events showed lower Hb values (p = 0.04). The level of anaemia was a prognostic factor of the combined endpoint (per gr/dl, HR 0.77 [0-61-0.98], p = 0.036). Conclusion Hemoglobin is predictive of poor outcomes in patients with significant TR. According to these preliminary results, iron deficiency could be a therapeutic target in this subgroup of patients with limited therapeutic options.

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.

scholarly journals Model for End-Stage Liver Disease Predicts Mortality for Tricuspid Valve Surgery

2009 ◽  
Vol 87 (5) ◽  
pp. 1460-1468 ◽  
Author(s):  
Gorav Ailawadi ◽  
Damien J. LaPar ◽  
Brian R. Swenson ◽  
Suzanne A. Siefert ◽  
Christine Lau ◽  
...  
Keyword(s):  
Liver Disease ◽  
Tricuspid Valve ◽  
Valve Surgery ◽  
End Stage Liver Disease ◽  
Tricuspid Valve Surgery ◽  
End Stage

Outcomes of tricuspid valve surgery in patients with functional tricuspid regurgitation

2020 ◽  
Author(s):  
Siddharth Pahwa ◽  
Nishant Saran ◽  
Alberto Pochettino ◽  
Hartzell Schaff ◽  
John Stulak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Valve Surgery ◽  
Late Mortality ◽  
Functional Tricuspid Regurgitation ◽  
Tricuspid Valve Surgery ◽  
Independent Risk Factors

Abstract OBJECTIVES Functional tricuspid regurgitation (fTR) has been amenable to tricuspid valve repair (TVr), with fewer patients needing tricuspid valve replacement (TVR). We sought to review our experience of tricuspid valve surgery for fTR. METHODS A retrospective analysis of adult patients (≥18 years) who underwent primary tricuspid valve surgery for fTR (n = 926; mean age 68.6 ± 12.5 years; 67% females) from January 1993 through June 2018 was conducted. There were 767 (83%) patients who underwent TVr (ring annuloplasty, 67%; purse-string annuloplasty, 33%) and 159 (17%) underwent TVR (bioprosthetic valves, 87%; mechanical valves, 13%). The median follow-up was 8.2 years [95% confidence interval (CI) 7.2–8.9 years]. RESULTS A greater proportion of patients who underwent TVR had severe right ventricular dysfunction (P &lt; 0.001), severe tricuspid regurgitation (P &lt; 0.001) and congestive heart failure (P = 0.001) while the TVr cohort had a greater proportion with severe mitral valve (MV) regurgitation (P &lt; 0.001) and concomitant cardiac procedures. Early mortality (TVR, 9% vs TVr, 3%; P = 0.004), renal failure (TVR, 10% vs TVr, 5%; P = 0.014) and hospital stay (TVR, 15 ± 15 days vs TVr, 12 ± 11 days; P &lt; 0.001) were greater in TVR patients. The TVR cohort had worse survival [hazard ratio (HR) 1.57; 95% CI 1.23–1.99]. Multivariable analysis identified congestive heart failure (HR 1.37; 95% CI 1.10–1.72), renal failure (HR 1.79; 95% CI 1.14–2.82), previous MV surgery (HR 1.35; 95% CI 1.05–1.72) and TVR (HR 1.36; 95% CI 1.03–1.79) as independent risk factors for late mortality. CONCLUSIONS Tricuspid repair for fTR appears to have better early and late outcomes. Since previous MV surgery and TVR are identified as independent risk factors for late mortality, concomitant TVr at the time of index MV surgery may be considered. Early referral before the onset of advanced heart failure may improve outcomes.

scholarly journals Simplified model for end-stage liver disease score predicts mortality for tricuspid valve surgery†

2013 ◽  
Vol 16 (5) ◽  
pp. 630-635 ◽  
Author(s):  
Kazumasa Tsuda ◽  
Masaaki Koide ◽  
Yoshifumi Kunii ◽  
Kazumasa Watanabe ◽  
Satoshi Miyairi ◽  
...  
Keyword(s):  
Liver Disease ◽  
Tricuspid Valve ◽  
Valve Surgery ◽  
Simplified Model ◽  
Disease Score ◽  
End Stage Liver Disease ◽  
Tricuspid Valve Surgery ◽  
End Stage

P6488Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Hinojar Baydes ◽  
A Garcia Martin ◽  
A Gonzalez-Gomez ◽  
M Martin-Plaza ◽  
M Sanroman-Guerrero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Valve Surgery ◽  
S Wave ◽  
Tricuspid Valve Surgery ◽  
Rv Function

Abstract Background Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function that can allow detection of subclinical RV dysfunction Purpose This study was aimed to evaluate the prognostic value of RV strain in stable patients with significant TR, in comparison with conventional parameters of RV systolic function. Methods Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave (`S) and with STE derived peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the 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). 5 patients were excluded due to poor acoustic window. According to ethyology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). Mean values of RV function parameters are shown in the table. During a median follow up of 18 months [IQR: 4–28], 37% of the patients reached the combined end point (n=15 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died). Patients with events showed impaired RV-GLS and FW-LS. Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes. Mean ± SD Mean ± SD Mean ± SD HR (95% confidence interval) P value in Cox regression analysis in all patients in patients with events in patients without events TAPSE 20±5 20±7 21±5 0.97 (0.9–1.06) 0.56 DTI S wave 10.5±2 11±3 10±2 1.08 (0.87–1.35) 0.49 FAC 44±7 43±6 45±8 1.04 (0.97–1.1) 0.22 FW longitudinal strain (FW-LS) 18±5 −16±5* −20±5 0.91 (0.84–0.98) 0.02 Global longitudinal strain (GLS) 19±4 −16±4* −21±4 0.87 (0.81–0.95) 0.001 Conclusion In patients with asymptomatic TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters may be included in the serial evaluation of these patients.

Tricuspid Valve Surgery in Right Heart Failure

2005 ◽  
pp. 97-122
Author(s):  
James P Greelish ◽  
Bradley J. Phillips ◽  
James C. Fang ◽  
John G. Byrne
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Right Heart Failure ◽  
Valve Surgery ◽  
Right Heart ◽  
Tricuspid Valve Surgery
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