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Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes

Julien Dreyfus 1, * Michele Flagiello 2 Baptiste Bazire 3 Florian Eggenspieler 4 Florence Viau 5 Elisabeth Riant 6 Yannick Mbaki 7 Yohann Bohbot 8, 9 Damien Eyharts 10 Thomas Sénage 11, 12 Henri Dubrulle 13 Martin Nicol 1 Fabien Doguet 14, 15 Virginia Nguyen 1 Augustin Coisne 16 Thierry Le Tourneau 17, 11 Yoan Lavie-Badie 10 Christophe Tribouilloy 8, 9 Erwan Donal 7 Jacques Tomasi 18, 7 Gilbert Habib 5, 19 Christine Selton-Suty 20 Richard Raffoul 3 Bernard Iung 3 J.-F. Obadia 2 David Messika-Zeitoun 21, *
Abstract : Aims: The aim of this study was to identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) and more specifically the impact of tricuspid regurgitation (TR) mechanism and clinical presentation.Methods and results: Among 5661 consecutive adult patients who underwent a tricuspid valve (TV) surgery at 12 French tertiary centres in 2007-2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease [47% in New York Heart Association (NYHA) III/IV, 57% with right-sided heart failure (HF) signs]. Tricuspid regurgitation was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31%, respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14% vs. 6%, P = 0.004), but presentation was more severe. Independent determinants of outcomes were NYHA Class III/IV [odd ratios (OR) = 2.7 (1.2-6.1), P = 0.01], moderate/severe right ventricular dysfunction [OR = 2.6 (1.2-5.8), P = 0.02], lower prothrombin time [OR = 0.98 (0.96-0.99), P = 0.008], and with borderline statistical significance, right-sided HF signs [OR = 2.4 (0.9-6.5), P = 0.06] while TR mechanism was not [OR = 0.7 (0.3-1.8), P = 0.88].Conclusion: Isolated TV surgery was associated with high mortality and morbidity, both in hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.
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Submitted on : Thursday, November 19, 2020 - 2:04:02 PM
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Julien Dreyfus, Michele Flagiello, Baptiste Bazire, Florian Eggenspieler, Florence Viau, et al.. Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes. European Heart Journal, Oxford University Press (OUP): Policy B, 2020, 41 (45), pp.4304-4317. ⟨10.1093/eurheartj/ehaa643⟩. ⟨hal-02959077⟩

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