Concomitant Surgery of Moderate Tricuspid Regurgitation—An Increase in Perioperative Risk for Elderly Patients?

 

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Background: Concomitant moderate tricuspid regurgitation (TR) is common in patients (pts) with mitral valve (MV) disease. In cases of dilated tricuspid valve (TV) annulus, there is reasonable evidence that TR ≤2 should be corrected at the time of MV surgery. However, the age of pts requiring MV surgery is increasing. It is well accepted that shorter operation time and duration on cardiopulmonary bypass (CPB) is mandatory when it comes to surgery in elderly pts. But concomitant TV repair might interfere with this. On the contrary, TV repair might prevent worsening of TR or deterioration of clinical and functional conditions. The aim of this study was to analyze the perioperative outcome (30 days after surgery) of pts older than 75 years receiving concomitant TV surgery due to dilated TV annulus and TR ≤2 and to compare these results with a younger cohort.

Methods: Between January 2006 and December 2017, 336 consecutive pts underwent first time MV surgery with concomitant TV ring annuloplasty and were enrolled in this retrospective study. The cohort was divided into two groups (Group A < 75 years and Group B ≥ 75 years) and analyzed regarding perioperative survival, adverse events, and functional status.

Results: Of 336 pts, 116 (35%) were ≥ 75 years. Older pts had a lower body weight (71 ± 13 vs. 77 ± 17 kg, p = 0.007). Younger pts presented more frequently with pleural effusion (25 vs. 15%, p = 0.037). No other differences were detected in preoperative functional status, as well as renal function and history of stroke. Preoperative echocardiographic findings were comparable, except better left ventricular (LV) function in older pts (good or mildly reduced LV ejection fraction: 88 vs. 76%, p = 0.010).

The duration of the operation, CPB, and aortic cross-clamp time were comparable, as well as number of pts with TV repair in beating heart technique. Lactate levels and dosage of catecholamines were also similar at the end of the operation. There were no differences between the groups with regard to intensive care unit or hospital stay.

Perioperative functional status (NYHA 1 and 2: 88% in each group) and echocardiographic findings (TR ≤1: 83% in each group) were also similar. Perioperative mortality (Group A: 5% vs. Group B 3%, p = 0.334) and adverse events, especially number of pacemaker implantations (23% in each group) were comparable between older and younger pts.

Conclusion: Concomitant TV annuloplasty in pts with dilated annulus and TR ≤ 2 does not increase perioperative morbidity or mortality in elderly pts.