Results after Tricuspid Valve Surgery for Preserved and Dysfunctional Right Ventricle

Abstract

Background This study aimed to compare long-term outcomes after tricuspid valve (TV) repair (TVr) with those after TV replacement (TVR) by adjusting the right ventricular (RV) volume and function.

Methods We enrolled 147 patients who underwent TVr (n = 78) and TVR (n = 69) for grade 3 or 4 tricuspid regurgitation and had preoperative cardiac magnetic resonance data. Long-term clinical outcomes were compared between the two groups using inverse probability treatment weighting (IPTW) to adjust for differences in preoperative characteristics between the two groups. Subgroup analyses were performed in patients with preserved and dysfunctional RV (ejection fraction < 50%).

Results There were no significant differences in operative mortality or postoperative complications between the two groups before and after the IPTW adjustment. Five- and 10-year overall survival rates were 84.2 and 67.1%, respectively. Five- and 10-year cumulative incidences of TV-related events (TVREs) were 33.1 and 55.6%, respectively. There were no significant differences in overall survival and cumulative incidence of TVREs after IPTW adjustment (p = 0.236 and p = 0.989, respectively). The risk-adjusted overall survival was marginally higher in the TVr group of patients with preserved RV function (p = 0.054), while no such significant difference was found between the two groups of patients with dysfunctional RV (p = 0.513).

Conclusion Adjusted long-term clinical outcomes after TVr and TVR were comparable. TVr might be beneficial for patients with preserved RV function in terms of long-term survival; however, this benefit might disappear in patients with RV dysfunction.

Keywords

tricuspid valve - magnetic resonance imaging - MRI - outcomes

• References

• 1 Kilic A, Saha-Chaudhuri P, Rankin JS, Conte JV. Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of Thoracic Surgeons database. Ann Thorac Surg 2013; 96 (05) 1546-1552 , discussion 1552
• 2 Singh SK, Tang GH, Maganti MD. et al. Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease. Ann Thorac Surg 2006; 82 (05) 1735-1741 , discussion 1741
• 3 Hwang HY, Kim KH, Kim KB, Ahn H. Treatment for severe functional tricuspid regurgitation: annuloplasty versus valve replacement. Eur J Cardiothorac Surg 2014; 46 (02) e21-e27
• 4 Choi JW, Jang MJ, Kim KH, Hwang HY. Repair versus replacement for the surgical correction of tricuspid regurgitation: a meta-analysis. Eur J Cardiothorac Surg 2018; 53 (04) 748-755
• 5 Marquis-Gravel G, Bouchard D, Perrault LP. et al. Retrospective cohort analysis of 926 tricuspid valve surgeries: clinical and hemodynamic outcomes with propensity score analysis. Am Heart J 2012; 163 (05) 851-858.e1
• 6 Chang HW, Jeong DS, Cho YH. et al. Tricuspid valve replacement vs. repair in severe tricuspid regurgitation. Circ J 2017; 81 (03) 330-338
• 7 Moraca RJ, Moon MR, Lawton JS. et al. Outcomes of tricuspid valve repair and replacement: a propensity analysis. Ann Thorac Surg 2009; 87 (01) 83-88 , discussion 88–89
• 8 Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Surgical outcomes of severe tricuspid regurgitation: predictors of adverse clinical outcomes. Heart 2013; 99 (03) 181-187
• 9 Haddad F, Hunt SA, Rosenthal DN, Murphy DJ. Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation 2008; 117 (11) 1436-1448
• 10 Karas MG, Kizer JR. Echocardiographic assessment of the right ventricle and associated hemodynamics. Prog Cardiovasc Dis 2012; 55 (02) 144-160
• 11 Hwang HY, Chang HW, Jeong DS, Ahn H. De Vega annuloplasty for functional tricupsid regurgitation: concept of tricuspid valve orifice index to optimize tricuspid valve annular reduction. J Korean Med Sci 2013; 28 (12) 1756-1761
• 12 Hwang HY, Kim KH, Kim KB, Ahn H. Propensity score matching analysis of mechanical versus bioprosthetic tricuspid valve replacements. Ann Thorac Surg 2014; 97 (04) 1294-1299
• 13 Choi JW, Kim KH, Chang HW. et al. Long-term results of annuloplasty in trivial-to-mild functional tricuspid regurgitation during mitral valve replacement: should we perform annuloplasty on the tricuspid valve or leave it alone?. Eur J Cardiothorac Surg 2018; 53 (04) 756-763
• 14 Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 2015; 34 (28) 3661-3679
• 15 Xu S, Ross C, Raebel MA, Shetterly S, Blanchette C, Smith D. Use of stabilized inverse propensity scores as weights to directly estimate relative risk and its confidence intervals. Value Health 2010; 13 (02) 273-277
• 16 Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999; 94 (446) 496-509
• 17 Schneider M, Ran H, Aschauer S. et al. Visual assessment of right ventricular function by echocardiography: how good are we?. Int J Cardiovasc Imaging 2019; 35 (11) 2001-2008
• 18 Park JH, Negishi K, Kwon DH, Popovic ZB, Grimm RA, Marwick TH. Validation of global longitudinal strain and strain rate as reliable markers of right ventricular dysfunction: comparison with cardiac magnetic resonance and outcome. J Cardiovasc Ultrasound 2014; 22 (03) 113-120
• 19 Makuch RW. Adjusted survival curve estimation using covariates. J Chronic Dis 1982; 35 (06) 437-443
• 20 Hu ZH, Peter Gale R, Zhang MJ. Direct adjusted survival and cumulative incidence curves for observational studies. Bone Marrow Transplant 2020; 55 (03) 538-543
• 21 Wang TKM, Griffin BP, Miyasaka R. et al. Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients. Open Heart 2020; 7 (01) e001227
• 22 Park SJ, Oh JK, Kim SO. et al. Determinants of clinical outcomes of surgery for isolated severe tricuspid regurgitation. Heart 2021; 107 (05) 403-410