Outcome and determinants of prognosis in patients undergoing isolated tricuspid valve surgery: retrospective single center analysis

Aims: Although tricuspid valve (TV) surgery has become more popular, isolated TV surgery is infrequently performed. The aims of this study were (1) to evaluate the postoperative and long-term mortality of patients undergoing isolated TV surgery, (2) to compare the outcomes of patients undergoing their first TV surgery or TV reoperation, and (3) to assess the additive value of echocardiographic and invasive hemodynamic evaluations for predicting postoperative outcome.

Methods: We followed a contemporary cohort of patients undergoing isolated TV surgery from January 1, 1995, through December 31, 2011. Preoperative demographic, echocardiographic, hemodynamic, and operative data were included. Outcome was all-cause mortality.

Results: Ninety-two patients (38% male; mean age: 56±14 years) were included. Kaplan-Meier survival analyses showed that 30-day, 3-month, 5-year, and 10-year mortality were 7.9%, 15.2%, 25.7%, and 53.7%, respectively. No difference in outcome was found between patients undergoing first TV surgery (n=61) and TV reoperation (n=31) (p=0.669). Univariable Cox analysis identified age (p<0.0001), extracardiac vascular disease (p=0.001), glomerular filtration rate (p=0.022), NYHA classification (p=0.010), and mean pulmonary artery pressure (p=0.005) as predictors of mortality. Multivariable analysis identified significant associations with outcome, only for age (p=0.010) and NYHA functional class (p=0.044). In younger patients (<59 years), mean pulmonary artery pressure was associated with the worse outcome (p=0.024).

Conclusions: Isolated TV surgery is still associated with important postoperative and long-term mortality, both for first TV surgery and TV reoperation. Pre-operative NYHA functional class and, in younger patients, pulmonary hypertension appear to determine prognosis.