Right heart failure and patient selection for isolated tricuspid valve surgery

Haytham Elgharably; Ahmed Ibrahim; Bradley Rosinski; Lucy Thuita; Eugene H Blackstone; Patrick H Collier; Gösta B Pettersson

doi:10.1016/j.jtcvs.2021.10.059

Right heart failure and patient selection for isolated tricuspid valve surgery

J Thorac Cardiovasc Surg. 2023 Sep;166(3):740-751.e8. doi: 10.1016/j.jtcvs.2021.10.059. Epub 2021 Nov 25.

Authors

Haytham Elgharably¹, Ahmed Ibrahim¹, Bradley Rosinski¹, Lucy Thuita², Eugene H Blackstone³, Patrick H Collier⁴, Gösta B Pettersson⁵

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
² Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
³ Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
⁴ Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
⁵ Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: gostaccf@gmail.com.

PMID: 35123790
DOI: 10.1016/j.jtcvs.2021.10.059

Abstract

Objective: To characterize patients with right heart failure undergoing isolated tricuspid valve surgery, focusing on right heart morphology and function.

Patients and methods: From January 2007 to January 2014, 62 patients underwent isolated tricuspid valve surgery. Forty-five patients (73%) had undergone previous heart operations. Right heart morphology and function variables were measured de novo from stored echocardiographic images, and clinical and hemodynamic data were extracted from patient registries and records. Cluster analysis was performed and outcomes assessed.

Results: On average, the right ventricle was dilated (diastolic area 32 cm²), but its function was preserved (free-wall strain -17% ± 5.8%) and right heart failure manifestations were moderate, with 40 (65%) having congested neck veins, 35 (56%) dependent edema, and 15 (24%) ascites. Average model for end-stage liver disease with sodium score was 11 ± 4.4, but individual values varied widely. Tricuspid valve variables split patients into 2 equal clusters: those with functional tricuspid regurgitation (TR) and those with structural TR. These groups had similar right ventricular function, but the functional TR group had worse right ventricular morphology and more severe manifestations of right heart failure, including greater model for end-stage liver disease with sodium scores (12 ± 44 vs 9.1 ± 3.9; P = .008). Both groups survived operation with low morbidity, but patients with functional TR had worse long-term survival, 48% versus 73% at 10 years after surgery.

Conclusions: The cluster analysis of patients with right heart failure undergoing isolated tricuspid valve surgery separated functional and structural tricuspid valve disease. Good early outcomes suggest expanding criteria for tricuspid valve surgery and earlier intervention for functional TR with right heart failure.

Keywords: cardiac surgery; cluster analysis; right ventricular function; tricuspid valve regurgitation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

End Stage Liver Disease* / surgery
Heart Failure* / diagnostic imaging
Heart Failure* / etiology
Heart Failure* / surgery
Heart Valve Prosthesis Implantation*
Humans
Patient Selection
Retrospective Studies
Severity of Illness Index
Sodium
Treatment Outcome
Tricuspid Valve / diagnostic imaging
Tricuspid Valve / surgery
Tricuspid Valve Insufficiency* / diagnostic imaging
Tricuspid Valve Insufficiency* / surgery

Substances

Sodium