When Is a Concomitant Mitral and Tricuspid Valve Repair a Bad Idea?

Background: Concomitant mitral and tricuspid valve repair is usually considered favorable. Patients benefit from concomitant repair of both AV valves. However, a proportion of patients show a poor outcome. The aim of this study was to investigate the risk factors for mortality associated with simultaneous double valve repair.

Method: After obtaining ethical approval, a total of 213 patients were included in the study between 2011 and 2021 after mitral and tricuspid repair. Baseline, cardiac and noncardiac comorbidities, extensive preoperative and postoperative echo diagnostic and laboratory parameters, postoperative complications, and in-hospital, 1-year, and long-term (5-year) mortality were obtained. The statistical survival, risk, uni-, and multivariate analysis were performed with R.

Results: Patients were predominantly male (55.4%), and mean age was 71.5 ± 7.9 years, with a mean log EuroSCORE of 19.7 ± 18.2. The primary analysis showed a significant association between in-hospital and 1-year mortality and EuroSCORE, CPB time, preoperative poor LVEF and TAPSE, increased PAP, preoperative renal and pulmonary disease, postoperative pericardial effusion, delirium, and renal failure. Based on univariate Cox proportional hazard model, the association of mortality was evident in EuroSCORE, CPB time, preoperative poor LVEF and TAPSE, and pre- and postoperative renal failure. After multivariate analysis, the significant influence on mortality was found in increased EuroSCORE (p = 0.007), prolonged CPB time (p = 0.036), and poor TAPSE (p = 0.031). One- and 5-year mortality rates due to cardiac and noncardiac causes were 24.4 and 28.6%, respectively. The leading cause of mortality was low-output syndrome.

Conclusion: In our selected, high-risk cohort, poor preoperative TAPSE as well as high EuroSCORE are the main factors influencing postoperative mortality after double valve repair. In these patients, indication for surgery should not be too generous. In contrast, other factors such as LVEF, PAP, etc. do not play a significant role. Moreover, prolonged CPB time seems to have a relevant impact on mortality suggesting that the surgical burden may be reduced by avoiding other concomitant procedures such as bypass surgery or even by considering repairing only the mitral valve and forgoing the tricuspid valve.

Publikationsverlauf

Artikel online veröffentlicht:
28. Januar 2023