Complicated postoperative course in isolated tricuspid valve surgery: Looking for predictors

Alessandra Sala*, Roberto Lorusso, Marta Bargagna, Stefania Ruggeri, Nicola Buzzatti, Mara Scandroglio, Fabrizio Monaco, Eustachio Agricola, Andrea Giacomini, Davide Carino, Roberta Meneghin, Davide Schiavi, Elisabetta Lapenna, Paolo Denti, Andrea Blasio, Ottavio Alfieri, Alessandro Castiglioni, Michele De Bonis

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

Abstract

Background This study aims at better defining the profile of patients with a complicated versus noncomplicated postoperative course following isolated tricuspid valve (TV) surgery to identify predictors of a favorable/unfavorable hospital outcome.

Methods All patients treated with isolated tricuspid surgery from March 1997 to January 2020 at our institution were retrospectively reviewed. Considering the complexity of most of these patients, a regular postoperative course was arbitrarily defined as a length-of-stay in intensive care unit less than 4 days and/or postoperative length-of-stay less than 10days. Patients were therefore divided accordingly in two groups.

Results One hundred and seventy-two patients were considered, among whom 97 (56.3%) had a regular (REG) and 75 (43.6%) a non-regular (NEG) postoperative course. The latter had worse baseline clinical and echocardiographic characteristics, with higher rate of renal insufficiency, previous heart failure hospitalizations, cardiac operations, and right ventricular dysfunction. NEG patients more frequently needed tricuspid replacement and experienced a greater number of complications (p < .001) and higher in-hospital mortality (13% vs. 0%, p < .001). The majority of these complications were related to more advanced stage of the tricuspid disease. Among most important predictors of a negative outcome univariate analysis identified chronic kidney disease, ascites, previous right heart failure hospitalizations, right ventricular dysfunction, previous cardiac surgeries, TV replacement and higher MELD scores. At multivariate analysis, liver enzymes and diuretics' dose were predictors of complicated postoperative course.

Conclusion In isolated TV surgery a complicated postoperative course is observed in patients with more advanced right heart failure and organ damage. Earlier surgical referral is associated to excellent outcomes and should be recommended.

Original languageEnglish
Pages (from-to)3092-3099
Number of pages8
JournalJournal of Cardiac Surgery
Volume36
Issue number9
DOIs
Publication statusPublished - Sep 2021

Keywords

  • hospital outcome
  • isolated tricuspid valve surgery
  • tricuspid regurgitation
  • tricuspid repair
  • tricuspid replacement
  • NATIVE VALVULAR REGURGITATION
  • EUROPEAN ASSOCIATION
  • DISEASE
  • SOCIETY
  • HEART
  • RECOMMENDATIONS
  • OUTCOMES
  • TRENDS

Cite this