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Hua K, Zhao R, Peng Z, Yang Y, Florian O, Mao B, Yang X. Early surgery can improve the outcomes of patients with severe tricuspid regurgitation undergoing tricuspid replacement. Cardiovasc Diagn Ther 2021; 11:1058-1066. [PMID: 34815956 DOI: 10.21037/cdt-21-311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022]
Abstract
Background Tricuspid regurgitation (TR) usually remains asymptomatic for a long time, such that it is most often diagnosed at an advanced stage of right heart failure. The purpose of this study was to identify clinical characteristics and overall outcomes in patients with severe TR who received tricuspid valve replacement (TVR) at different clinical stages. Methods Between 1993 and 2018, 256 severe TR patients who received TVR alone or in combination with other procedures were assessed at Beijing Anzhen Hospital. Ninety-three patients underwent New York Heart Association (NYHA) class I/II operations (early surgery group), and the others underwent NYHA class III/IV operations. The primary outcome was in-hospital and long-term mortality. Clinical outcomes were evaluated by the Kaplan-Meier method and Cox regression models. Follow-up was conducted annually. Propensity score matching and overlap propensity score weighting were performed as sensitivity analyses. Results Postoperative complications, including low cardiac output (11.8% vs. 26.4%, P<0.001), renal failure (2.2% vs. 16.6%, P<0.001), and bleeding (3.2% vs. 11.7%, P=0.037), were significantly lower in the NYHA class I/II group than in the NYHA III/IV group. Patients in the NYHA class III/IV group had a significantly higher incidence of in-hospital mortality (18.4% vs. 5.4%, P<0.001) and long-term mortality (33.7% vs. 11.8%, P=0.006) after follow-up (median follow-up duration =63 months). The results indicated a consistently higher occurrence rate in the propensity score-matched cohort and overlap propensity score weighted analysis. Conclusions Consistent with the recent clinical trend to provide earlier and more aggressive TR intervention, our results indicate that surgery for severe TR patients should be considered before advanced heart failure develops, when patients are asymptomatic or mildly symptomatic (NYHA class I/II).
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Affiliation(s)
- Kun Hua
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Rui Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhan Peng
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Yunxiao Yang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Osmanaj Florian
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Bin Mao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China
| | - Xiubin Yang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Vessel Disease, Beijing, China.,Department of Cardiovascular Surgery, Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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