Beating Versus Arrested Heart Isolated Tricuspid Valve Surgery: Long-term Outcomes.

Europe / epidemiology Female Follow-Up Studies Heart Arrest, Induced / methods Heart Valve Prosthesis Implantation / methods Humans Incidence Male Middle Aged Postoperative Complications / epidemiology Propensity Score Reoperation Retrospective Studies Risk Factors Survival Rate / trends Time Factors Tricuspid Valve / surgery Tricuspid Valve Insufficiency / surgery

Journal

The Annals of thoracic surgery

ISSN: 1552-6259

Titre abrégé: Ann Thorac Surg

Pays: Netherlands

ID NLM: 15030100R

Informations de publication

Date de publication:
Feb 2022

Historique:

received: 10 08 2020

revised: 22 02 2021

accepted: 15 03 2021

pubmed: 9 4 2021

medline: 4 2 2022

entrez: 8 4 2021

Statut: ppublish

Résumé

Isolated tricuspid valve (TV) surgery is a rare procedure generally considered at high risk for perioperative mortality and poor long-term outcomes. Surgical treatment can be performed with either an arrested heart (AH) or beating heart (BH) technique. The aim of this study was to compare the outcomes of isolated tricuspid surgery with 2 different approaches. The Surgical-Tricuspid Study is a multicenter international retrospective study enrolling adult patients who underwent isolated TV procedures (n = 406; age 56 ± 16 years; 56% female) at 13 international sites. The AH and BH strategies were performed in 253 and 153 patients, respectively. Propensity score-matched analysis was used to compare groups. After matching, 129 pairs were obtained and analyzed. The 30-day mortality rate was 6.2% versus 5.0% in the AH and BH groups, respectively (P = .9). The rates of acute renal failure requiring replacement therapy (10% versus 3%; P = .02) and stroke (1.6% versus 0%; P = .08) were numerically higher in the AH group. The 6-year survival rate was 67% ± 6% versus 78% ± 5% in the AH and BH groups, respectively (P = .18), whereas freedom from cardiac death was 75% ± 5% versus 84% ± 4% (P = .21). The 6-year composite cardiac end point of cardiac death and reoperation rate was 60% ± 9% versus 86% ± 5% (P = .024) comparing AH-TV replacement and BH-TV repair groups. Isolated TV surgery performed with a BH strategy is a safe option and resulted in a trend of increased long-term survival and freedom from reoperation compared with the standard AH technique. Patients undergoing BH valve repair had the best long-term outcome.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

The Surgical-Tricuspid Study is a multicenter international retrospective study enrolling adult patients who underwent isolated TV procedures (n = 406; age 56 ± 16 years; 56% female) at 13 international sites. The AH and BH strategies were performed in 253 and 153 patients, respectively. Propensity score-matched analysis was used to compare groups.

RESULTS RESULTS

After matching, 129 pairs were obtained and analyzed. The 30-day mortality rate was 6.2% versus 5.0% in the AH and BH groups, respectively (P = .9). The rates of acute renal failure requiring replacement therapy (10% versus 3%; P = .02) and stroke (1.6% versus 0%; P = .08) were numerically higher in the AH group. The 6-year survival rate was 67% ± 6% versus 78% ± 5% in the AH and BH groups, respectively (P = .18), whereas freedom from cardiac death was 75% ± 5% versus 84% ± 4% (P = .21). The 6-year composite cardiac end point of cardiac death and reoperation rate was 60% ± 9% versus 86% ± 5% (P = .024) comparing AH-TV replacement and BH-TV repair groups.

CONCLUSIONS CONCLUSIONS

Isolated TV surgery performed with a BH strategy is a safe option and resulted in a trend of increased long-term survival and freedom from reoperation compared with the standard AH technique. Patients undergoing BH valve repair had the best long-term outcome.

Identifiants

DOI: 10.1016/j.athoracsur.2021.03.070 PMID: 33831392

pubmed: 33831392

pii: S0003-4975(21)00649-4

doi: 10.1016/j.athoracsur.2021.03.070

pii:

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

585-592