Outcome of Concomitant Tricuspid Valve Surgery in Patients with Mild or Moderate Tricuspid Valve Regurgitation

Objectives: To evaluate the outcome of concomitant tricuspid valve (TV) surgery in patients (pts) with mild or moderate tricuspid valve regurgitation (TR) and dilated TV annulus.

Methods: Between January 2006 and December 17, 336 consecutive patients received concomitant TV surgery in our institution and were enrolled in this retrospective study. Thirty-day outcome was compared between two groups of pts. Group 1 (Gr. 1) included pts with mild or moderate TR (TR grade ≤ 2), whereas group 2 (Gr. 2) with severe TR, respectively.

Results: Gr. 1 consists of 163 pts (49%) and Gr. 2 of 173 pts (51%). Pts in Gr. 2 suffered more frequently from atrial fibrillation (77 vs. 64%, p = 0.009) and presented with a higher NYHA functional class (Class III or IV, 62 vs. 51%, p = 0.044). The peripheral edema (38 vs. 28%, p = 0.042) and pleural effusion (28 vs. 14%, p = 0.003) were also higher in Gr. 2. The comparison of echocardiographic data revealed better right ventricular (RV) performance in Gr. 1 (TAPSE 18 ± 5 vs. 16 ± 5 mm in Gr. 2, p < 0.001). Preoperative RV dilatation was absent in 77% in Gr. 1 vs. 54% in Gr. 2 (p < 0.001). No differences were detected in cardiopulmonary bypass and aortic cross-clamp times. The type of concomitant procedure was also comparable between the groups. At the end of the operation, higher dosage of epinephrine was administered to support the circulation in pts from Gr. 2 (0.04 ± 0.06 vs. 0.02 ± 0.04 µg/kg/min, p = 0.030). No difference was detected in perioperative complications. The 30-day mortality was 6% (n = 9) in Gr.1 and 4% (n = 7) in Gr. 2 (p = 0.492). During early postoperative follow-up, pts from Gr. 1 suffered less frequently from peripheral edema (33 vs. 45%, p = 0.031) and pleural effusion (23 vs. 34%, p = 0.045). Postoperative echocardiography revealed TR grade ≤1 in 92% of the pts from Gr. 1 vs. 84% in Gr. 2 (p = 0.025).

Conclusion: In this study, pts with TR grade ≤ 2 were in better preoperative clinical condition, had better preoperative RV function, and presented with lower perioperative morbidity. Therefore, surgical correction of TR should be done before irreversible damage is sustained to the right ventricle. Concomitant prophylactic surgery of TR may improve early postoperative outcome.