High Efficacy and Low Early Mortality in High-Volume Center Tricuspid Valve Surgery

Julia Götte; Armin Zittermann; René Schramm; Sabine Bleiziffer; Markus André Deutsch; André Renner; Jan F Gummert

doi:10.1055/a-2048-8199

High Efficacy and Low Early Mortality in High-Volume Center Tricuspid Valve Surgery

Thorac Cardiovasc Surg. 2023 Apr 21. doi: 10.1055/a-2048-8199. Online ahead of print.

Authors

Julia Götte¹, Armin Zittermann¹, René Schramm¹, Sabine Bleiziffer¹, Markus André Deutsch¹, André Renner¹, Jan F Gummert¹

Affiliation

¹ Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Ruhr-University Bochum, Germany.

PMID: 36882159
DOI: 10.1055/a-2048-8199

Abstract

Background: Isolated tricuspid valve surgery has been associated with early mortality rates of up to 10%. With rapidly emerging interventional catheter-based options, the question arises whether current technical and perioperative protocols in cardiac surgery translate into lower than previously expected mortality rates, especially when looking at data from high-volume centers.

Methods: We performed a retrospective single-center analysis in 369 patients undergoing isolated tricuspid valve repair (n = 256) or replacement (n = 113) between 2009 and 2021. Surgical approaches included full sternotomy, as well as right-sided minithoracotomy. According to a recently introduced clinical risk score, patients were divided into scoring groups, and observed (O) versus expected (E) early mortality were compared. Pre- and postoperative tricuspid valve function was also analyzed.

Results: Overall, 30-day mortality was 4.1%, ranging from 0% (scoring group 0-1 points) to 8.7% (scoring group ≥ 10 points), which was substantially lower than the expected early mortality (2% in the lowest to 34% in the highest scoring group). Preoperative tricuspid regurgitation was severe in 71.3% (n = 263), moderate to severe in 14.9% (n = 55), and mild or less in 6.5% (n = 24). The corresponding postoperative values were 0% (n = 0), 1.4% (n = 5), and 81.6% (n = 301).

Conclusion: Our high-volume center data indicate substantially lower than predicted 30-day mortality in different cardiac surgical risk scoring groups. The majority of patients had zero to minimal residual tricuspid valve insufficiency postoperatively. Randomized controlled trials are needed to compare tricuspid valve functional results and long-term outcomes of surgical versus interventional procedures in patients undergoing isolated tricuspid valve procedures.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).