Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery

Nicola Buzzatti, Giuseppe Iaci, Maurizio Taramasso, Teodora Nisi, Elisabetta Lapenna, Michele De Bonis, Francesco Maisano, Ottavio Alfieri

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To assess long-term outcomes of tricuspid valve replacement (TVR) after previous left-side heart surgery. METHODS: We reviewed reoperative TVR after left-side heart surgery performed at our institution between March 1997 and June 2012. In-hospital data were retrieved from our institutional database or medical records; follow-up was performed through telephone call, surviving patients being asked to provide a recent (≤6 months) echocardiogram. RESULTS: Reoperative TVR was performed in 117 patients. Preoperative characteristics included: mean age 63.7 years, median logistic EuroSCORE (LES) 11.8, New York Heart Association (NYHA) class >2 in 79.5% of patients, right ventricle (RV) dysfunction >mild in 23.9% of patients and mean systolic pulmonary artery pressure (sPAP) 48.4 mmHg. A mechanical prosthesis was implanted in 5.1% of patients. A right thoracotomy was preferred to median sternotomy in 8.6% of cases. Isolated-TVR (I-TVR) was performed in 52.1% of patients, a beating-heart approach being used in 85.2% of I-TVR cases. Postoperative RV failure occurred in 46.1% of patients. Median length-of-stay was 11.5 days. Thirty-day mortality was 6.0% overall and 8.2% in the I-TVR group. Higher preoperative LES (P = 0.002), ascites (P = 0.004), RV dysfunction (P = 0.033) and sPAP (P = 0.046) were associated with acute mortality. No significant difference in acute outcomes was observed between beating and arrested-heart I-TVR, except for postoperative median length-of-stay (9 vs 28 days, respectively, P = 0.007). Among survivors median follow-up time was 5.1 years. Five-year and 10-year freedom from cardiac death were 79.4 and 61.0%, freedom from tricuspid reoperation were 97.3 and 87.5%, freedom from bioprosthesis degeneration were 92.8 and 74.3%, respectively. Five-year and 10-year survival in the I-TVR subgroup were respectively 74.4 and 61.6%. Higher preoperative sPAP was associated with increased follow-up mortality (P = 0.048). At the last follow-up, NYHA class I-II was found in 86.1% of surviving patients. CONCLUSIONS: In selected cases, TVR is currently feasible with low acute mortality, especially if performed in the absence of ascites, significant RV dysfunction and pulmonary hypertension. Long-term mortality remains more difficult to predict, although it appeared to be also associated with higher preoperative pulmonary pressure. The global high-complexity profile of these patients is likely to impair longterm outcomes.

Original languageEnglish
Article numberezt638
Pages (from-to)713-719
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume46
Issue number4
DOIs
Publication statusPublished - Oct 1 2014

Fingerprint

Tricuspid Valve
Thoracic Surgery
Heart Ventricles
Mortality
Pulmonary Artery
Pressure
Ascites
Length of Stay
Bioprosthesis
Sternotomy
Patient Rights
Thoracotomy
Reoperation
Pulmonary Hypertension
Telephone
Prostheses and Implants
Medical Records
Survivors
Databases
Lung

Keywords

  • Left side
  • Reoperative
  • Replacement
  • Right ventricle
  • Tricuspid

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery. / Buzzatti, Nicola; Iaci, Giuseppe; Taramasso, Maurizio; Nisi, Teodora; Lapenna, Elisabetta; De Bonis, Michele; Maisano, Francesco; Alfieri, Ottavio.

In: European Journal of Cardio-thoracic Surgery, Vol. 46, No. 4, ezt638, 01.10.2014, p. 713-719.

Research output: Contribution to journalArticle

Buzzatti, Nicola ; Iaci, Giuseppe ; Taramasso, Maurizio ; Nisi, Teodora ; Lapenna, Elisabetta ; De Bonis, Michele ; Maisano, Francesco ; Alfieri, Ottavio. / Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery. In: European Journal of Cardio-thoracic Surgery. 2014 ; Vol. 46, No. 4. pp. 713-719.
@article{9be3285010654c2ba653c73e739cb9cc,
title = "Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery",
abstract = "OBJECTIVES: To assess long-term outcomes of tricuspid valve replacement (TVR) after previous left-side heart surgery. METHODS: We reviewed reoperative TVR after left-side heart surgery performed at our institution between March 1997 and June 2012. In-hospital data were retrieved from our institutional database or medical records; follow-up was performed through telephone call, surviving patients being asked to provide a recent (≤6 months) echocardiogram. RESULTS: Reoperative TVR was performed in 117 patients. Preoperative characteristics included: mean age 63.7 years, median logistic EuroSCORE (LES) 11.8, New York Heart Association (NYHA) class >2 in 79.5{\%} of patients, right ventricle (RV) dysfunction >mild in 23.9{\%} of patients and mean systolic pulmonary artery pressure (sPAP) 48.4 mmHg. A mechanical prosthesis was implanted in 5.1{\%} of patients. A right thoracotomy was preferred to median sternotomy in 8.6{\%} of cases. Isolated-TVR (I-TVR) was performed in 52.1{\%} of patients, a beating-heart approach being used in 85.2{\%} of I-TVR cases. Postoperative RV failure occurred in 46.1{\%} of patients. Median length-of-stay was 11.5 days. Thirty-day mortality was 6.0{\%} overall and 8.2{\%} in the I-TVR group. Higher preoperative LES (P = 0.002), ascites (P = 0.004), RV dysfunction (P = 0.033) and sPAP (P = 0.046) were associated with acute mortality. No significant difference in acute outcomes was observed between beating and arrested-heart I-TVR, except for postoperative median length-of-stay (9 vs 28 days, respectively, P = 0.007). Among survivors median follow-up time was 5.1 years. Five-year and 10-year freedom from cardiac death were 79.4 and 61.0{\%}, freedom from tricuspid reoperation were 97.3 and 87.5{\%}, freedom from bioprosthesis degeneration were 92.8 and 74.3{\%}, respectively. Five-year and 10-year survival in the I-TVR subgroup were respectively 74.4 and 61.6{\%}. Higher preoperative sPAP was associated with increased follow-up mortality (P = 0.048). At the last follow-up, NYHA class I-II was found in 86.1{\%} of surviving patients. CONCLUSIONS: In selected cases, TVR is currently feasible with low acute mortality, especially if performed in the absence of ascites, significant RV dysfunction and pulmonary hypertension. Long-term mortality remains more difficult to predict, although it appeared to be also associated with higher preoperative pulmonary pressure. The global high-complexity profile of these patients is likely to impair longterm outcomes.",
keywords = "Left side, Reoperative, Replacement, Right ventricle, Tricuspid",
author = "Nicola Buzzatti and Giuseppe Iaci and Maurizio Taramasso and Teodora Nisi and Elisabetta Lapenna and {De Bonis}, Michele and Francesco Maisano and Ottavio Alfieri",
year = "2014",
month = "10",
day = "1",
doi = "10.1093/ejcts/ezt638",
language = "English",
volume = "46",
pages = "713--719",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "4",

}

TY - JOUR

T1 - Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery

AU - Buzzatti, Nicola

AU - Iaci, Giuseppe

AU - Taramasso, Maurizio

AU - Nisi, Teodora

AU - Lapenna, Elisabetta

AU - De Bonis, Michele

AU - Maisano, Francesco

AU - Alfieri, Ottavio

PY - 2014/10/1

Y1 - 2014/10/1

N2 - OBJECTIVES: To assess long-term outcomes of tricuspid valve replacement (TVR) after previous left-side heart surgery. METHODS: We reviewed reoperative TVR after left-side heart surgery performed at our institution between March 1997 and June 2012. In-hospital data were retrieved from our institutional database or medical records; follow-up was performed through telephone call, surviving patients being asked to provide a recent (≤6 months) echocardiogram. RESULTS: Reoperative TVR was performed in 117 patients. Preoperative characteristics included: mean age 63.7 years, median logistic EuroSCORE (LES) 11.8, New York Heart Association (NYHA) class >2 in 79.5% of patients, right ventricle (RV) dysfunction >mild in 23.9% of patients and mean systolic pulmonary artery pressure (sPAP) 48.4 mmHg. A mechanical prosthesis was implanted in 5.1% of patients. A right thoracotomy was preferred to median sternotomy in 8.6% of cases. Isolated-TVR (I-TVR) was performed in 52.1% of patients, a beating-heart approach being used in 85.2% of I-TVR cases. Postoperative RV failure occurred in 46.1% of patients. Median length-of-stay was 11.5 days. Thirty-day mortality was 6.0% overall and 8.2% in the I-TVR group. Higher preoperative LES (P = 0.002), ascites (P = 0.004), RV dysfunction (P = 0.033) and sPAP (P = 0.046) were associated with acute mortality. No significant difference in acute outcomes was observed between beating and arrested-heart I-TVR, except for postoperative median length-of-stay (9 vs 28 days, respectively, P = 0.007). Among survivors median follow-up time was 5.1 years. Five-year and 10-year freedom from cardiac death were 79.4 and 61.0%, freedom from tricuspid reoperation were 97.3 and 87.5%, freedom from bioprosthesis degeneration were 92.8 and 74.3%, respectively. Five-year and 10-year survival in the I-TVR subgroup were respectively 74.4 and 61.6%. Higher preoperative sPAP was associated with increased follow-up mortality (P = 0.048). At the last follow-up, NYHA class I-II was found in 86.1% of surviving patients. CONCLUSIONS: In selected cases, TVR is currently feasible with low acute mortality, especially if performed in the absence of ascites, significant RV dysfunction and pulmonary hypertension. Long-term mortality remains more difficult to predict, although it appeared to be also associated with higher preoperative pulmonary pressure. The global high-complexity profile of these patients is likely to impair longterm outcomes.

AB - OBJECTIVES: To assess long-term outcomes of tricuspid valve replacement (TVR) after previous left-side heart surgery. METHODS: We reviewed reoperative TVR after left-side heart surgery performed at our institution between March 1997 and June 2012. In-hospital data were retrieved from our institutional database or medical records; follow-up was performed through telephone call, surviving patients being asked to provide a recent (≤6 months) echocardiogram. RESULTS: Reoperative TVR was performed in 117 patients. Preoperative characteristics included: mean age 63.7 years, median logistic EuroSCORE (LES) 11.8, New York Heart Association (NYHA) class >2 in 79.5% of patients, right ventricle (RV) dysfunction >mild in 23.9% of patients and mean systolic pulmonary artery pressure (sPAP) 48.4 mmHg. A mechanical prosthesis was implanted in 5.1% of patients. A right thoracotomy was preferred to median sternotomy in 8.6% of cases. Isolated-TVR (I-TVR) was performed in 52.1% of patients, a beating-heart approach being used in 85.2% of I-TVR cases. Postoperative RV failure occurred in 46.1% of patients. Median length-of-stay was 11.5 days. Thirty-day mortality was 6.0% overall and 8.2% in the I-TVR group. Higher preoperative LES (P = 0.002), ascites (P = 0.004), RV dysfunction (P = 0.033) and sPAP (P = 0.046) were associated with acute mortality. No significant difference in acute outcomes was observed between beating and arrested-heart I-TVR, except for postoperative median length-of-stay (9 vs 28 days, respectively, P = 0.007). Among survivors median follow-up time was 5.1 years. Five-year and 10-year freedom from cardiac death were 79.4 and 61.0%, freedom from tricuspid reoperation were 97.3 and 87.5%, freedom from bioprosthesis degeneration were 92.8 and 74.3%, respectively. Five-year and 10-year survival in the I-TVR subgroup were respectively 74.4 and 61.6%. Higher preoperative sPAP was associated with increased follow-up mortality (P = 0.048). At the last follow-up, NYHA class I-II was found in 86.1% of surviving patients. CONCLUSIONS: In selected cases, TVR is currently feasible with low acute mortality, especially if performed in the absence of ascites, significant RV dysfunction and pulmonary hypertension. Long-term mortality remains more difficult to predict, although it appeared to be also associated with higher preoperative pulmonary pressure. The global high-complexity profile of these patients is likely to impair longterm outcomes.

KW - Left side

KW - Reoperative

KW - Replacement

KW - Right ventricle

KW - Tricuspid

UR - http://www.scopus.com/inward/record.url?scp=84919967667&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84919967667&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezt638

DO - 10.1093/ejcts/ezt638

M3 - Article

C2 - 24477739

AN - SCOPUS:84919967667

VL - 46

SP - 713

EP - 719

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 4

M1 - ezt638

ER -