Optimising Tricuspid Regurgitation Surgery: Risk Factors and Clinical Implications

C. Q.Y.. Tan¹, D. Zannino², B. Robinson¹, P. Bannon^3
1Royal Prince Alfred Hospital, Camperdown, New South Wales ²Murdoch Children’s Research Institute, Parkville, Victoria ³University of Sydney, Sydney, NSW

Purpose: Tricuspid regurgitation(TR) has been increasingly recognized to be associated with deleterious outcomes but remains undertreated. We investigated the outcomes of tricuspid valve surgery(TVS) in a quaternary centre.

Methods: Data from 214 patients who underwent TVS between 2009-2020 were obtained and they were separated into 3 groups. Group A describes 101 patients who had low-moderate TR and no right ventricle dysfunction(RVD); Groups B describes 74 patients with severe TR and no RVD; Groups C describes 39 patients with severe TR and RVD.

Results: The mean age at surgery was 64±15 years-old and there were 101 females. Mean EuroSCORE II was 5.6±9.3, mean hospital length of stay(LOS) was 18±25 days and mean intensive care unit LOS was 10±27 days. The total mean follow-up time was 13±26 months. There were 41(19%) deaths post TVS at a mean age of 71±16 years old and a mean time of 29±37 months post tricuspid valve surgery. Patients with severe TR and RVD (Group C) were at a higher risk of death(HR 3.07 (1.25-7.55);p=0.0192) compared to Group A and B. Other risk factors for death include pre-op creatinine>150(p=0.009), pre-op PVD(p=0.016), pre-op NYHA class 3 and above(p=0.005), pre-op thienopyrine(p=0.001) and pre-op pulmonary hypertension(p=0.004).

Conclusion: This data from a large quaternary center found that patients with severe TR and RVD are at a higher risk of mortality than those without. We encourage surgeons to consider early operation on patients with TR before RVD occurs.

Identify the source of the funding for this research project: N/a