Subscribe to RSS
DOI: 10.1055/s-0038-1627968
Predictors for Perioperative Mortality following Tricuspid Valve Surgery
Publication History
Publication Date:
22 January 2018 (online)
Background: Indications for surgery and associated risks are clear for patients with diseased mitral and/or aortic valve. But there is still an ongoing debate whether and when the tricuspid valve (TV) disease should be operated. Study results and experts are controversial concerning this delicate problem. Understanding the risk of surgery of TV is of interest because the risk assessment will influence not only the decision to operate but even more the choice of intervention and its timing. Aim of this study is to identify the preoperative risk-factors for perioperative mortality and to support the risk assessment of patients undergoing surgery of the TV.
Methods: Between 01/09 and 07/17, a total of 383 patients with isolated TV regurgitation (TR) and in combination with other valve disease were enrolled in this retrospective study. Risk-factors leading to death were analyzed using univariate Cox regression analysis.
Results: In this period 27 patients (7%) received replacement of TV with biological prosthesis and remaining 356 patients (93%) received repair of TV with annuloplasty ring. The perioperative mortality was 6.7%. These patients died 12 ± 12 days after surgery. Perioperative risk-factors for mortality were previous operation of mitral valve (22% versus 9%, p = 0.040, OR 1.692 CI 1.023–2.791), advanced stage of heart failure associated with impaired functional status (NYHA IV 22% versus 6%, p = 0.005, OR 2.008, CI 1.239–3.388), ascites (26% versus 7%, p = 0.001, OR 2.247, CI 1.4–3.61), pleural effusion (48% versus 19%, p = 0.011, OR 1.739, CI 1.138–2.653) and preoperative number of cardiac decompensations (1.4 ± 1.4 versus 0.65 ± 0.78, p < 0.001, OR 1.932, CI 1.411–2.64). patients with severely reduced left (26% versus 9%, p = 0.008, OR 1.898, CI 1.182–3.049) and right (35% versus 13%, p = 0.002, OR 1.992, CI 1.282–3.1) ventricular function presented also with increased perioperative mortality.
Conclusion: Previous operation of mitral valve is associated with increased perioperative risk for mortality. Apparently reduced clinical condition and advanced stage of cardiac failure bear the risk for poor perioperative outcome.