Tricuspid valve repair in patients with mild-to-moderate tricuspid regurgitation undergoing mitral valve repair/replacement improves in-hospital outcome

Objectives: Significant tricuspid regurgitation (TR) in patients (pts) undergoing surgery for mitral valve (MV) does increase their morbidity and mortality. The early postoperative period demonstrates the most vulnerable phase for hemodynamic stabilisation at ICU after MV surgery. Does reconstruction of mild-to-moderate insufficiency of the tricuspid valve (TV) in pts undergoing MV surgery lead to a benefit in early postoperative outcome?

Methods: From January 2010 to September 2012, 22 patients with mild-to-moderate functional TR underwent first-time mitral valve repair/replacement and concomitant TV repair. The severity of TR was assessed echocardiographically by using colour-Doppler flow images. Additional procedures included coronary artery bypass in 9 pts and maze procedure in 15 pts. Following parameters were compared: postoperative doses and peak doses of noradrenaline (NA), pre-/postoperative systolic pulmonary arterial pressure (sPAP), extubation time, operation time, cross-clamp time, cardiopulmonary bypass (CPB) time, pre-/postoperative ejection fraction (EF), ICU-Stay, hospital-stay, cellsaver transfusion, blood transfusion intra-/postoperative, postoperative TR.

Results: The mean age was 67 years (± 14,8), 45% were male. All pts underwent successful mitral valve repair. Mean ejection fraction was 47% (± 16.2), postoperative 52% (± 12.4). Preoperative sPAP 46 mmHg (± 20.1), postoperative sPAP 40.6 mmHg (± 9.4), postoperative NA 12 mcg/min (± 10), peak NA 18 mcg/min (± 11), operation time 275 min (± 92), CPB time 145 min (± 49), ICU stay 2.4 days (± 2.4), hospital stay 10.8 days (± 3.5), cellsaver 736 ml (346 ± ), blood transfusion 2.5 (± 1,6) intraoperative. 2 pts needed blood transfusion after operation. 19 pts were extubated at first postoperative day, 2 pts at second day and 1 at fourth postoperative day after reoperation because of bleeding complications. 2 pts required a permanent pacemaker for heart block. No reintubation, no in-hospital mortality, one reoperation because of bleeding complications. 14 pts had no sign of TR, 7 pts mild TR and 1pt moderate TR at the discharge echocardiogram.

Conclusion: Correction of mild-to-moderate functional TR at the time of MV repair does maintain TV function and avoid Right Ventricular dysfunction in the early postoperative period. This strategy improves clinical outcomes at ICU and hospital stay.