Supporting Heart Team-Based Decision Making - risk Prediction in Minimally Invasive Tricuspid Valve Surgery

Background: Historically, patients with isolated tricuspid valve disease have faced elevated mortality rates. Minimally invasive tricuspid surgery (MIC-TVS) through anterolateral minithoracotomy holds potential to improve outcomes by minimizing surgical trauma. This study aims to present current outcomes of MIC-TVS and assess performance of contemporary risk scores.

Methods: This retrospective observational multi-center study utilized the TRI-SCORE (parameters: age, NYHA, signs of right-sided heart failure, furosemide dosage, glomerular filtration rate (GFR), bilirubin levels, left ventricular ejection fraction, and moderate or severe right ventricular dysfunction) and four stages of right heart failure (based on tricuspid annular plane systolic excursion (TAPSE), NYHA, diuretic medication, and presence of peripheral edema) as risk scores. Additionally, the “LaPar-Score” was calculated (age, sex, prior stroke, hemodialysis, chronic lung disease, left ventricular ejection fraction, NYHA, re-operation, and procedure urgency).

Results: Between 2017 and 2023, 38 patients underwent MIC-TVS. Of these, 89.5% (34/38) were beating heart procedures. Mean age was 65.8 years (95% confidence interval 60.6–71.1), mean BMI was 27.0 (25.1–28.9). Mean TRI-SCORE was 4.6 points (95% CI 3.9–5.2), EuroSCORE II was 6.5% (4.9–8.0), and LaPar-Score was 13.1% (9.7–16.5). Among scores, TRI-SCORE was highly predictive of 30-day mortality (AUC = 0.843), Youden Index determined a threshold of 6 points, which also reliably predicted survival in the first 6 months after surgery (6-months survival 92% vs. 56% in TRI-SCORE <6 vs. 6 or higher, p = 0.03). LaPar Score did not show sufficient predictive ability (AUC=0.671), nor did survival analysis according to four stages of right heart failure (p = 0.986). 30-day mortality among all patients was 7.9% (3/38).

Conclusion: Patients with isolated tricuspid valve disease remain a surgical challenge, as evidenced by a 7.9% 30-day mortality rate, consistent with international reports. The TRI-SCORE emerged as a robust predictor of outcomes, surpassing other methods like the LaPar Score or stage-based categorization of RHF patients. TRI-SCORE not only predicted perioperative mortality but also forecasted survival within the initial 6 months postsurgery. Patients with a TRI-SCORE ≥6 points may not benefit from surgery and could be offered interventional treatment options.

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Artikel online veröffentlicht:
13. Februar 2024