Impact of tricuspid regurgitation with and without repair during aortic valve replacement

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 162; no. 1; pp. 44 - 50.e2
• Main Authors: Chancellor, William Z., Mehaffey, J. Hunter, Beller, Jared P., Hawkins, Robert B., Speir, Alan M., Quader, Mohammed A., Yarboro, Leora T., Teman, Nicholas R., Ailawadi, Gorav
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2021
• Subjects: Adult; Aged; Aged, 80 and over; aortic valve replacement; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Case-Control Studies; Female; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Incidence; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Propensity Score; Retrospective Studies; Risk Factors; Severity of Illness Index; Treatment Outcome; tricuspid regurgitation; Tricuspid Valve Insufficiency - complications; Tricuspid Valve Insufficiency - epidemiology; Tricuspid Valve Insufficiency - surgery; tricuspid valve repair; tricuspid regurgitation; AS; STS; aortic valve replacement; MR; VCSQI; tricuspid valve repair; IQR; AVR; TR
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2020.02.033

Long-term outcomes of aortic valve replacement (AVR) are worse in patients with tricuspid regurgitation (TR), but the impact of concomitant tricuspid valve intervention remains unclear. The purpose of this study was to determine the effect of tricuspid intervention in patients with TR undergoing AVR.
Patients undergoing AVR in a regional Society of Thoracic Surgeons database (2001-2017) were stratified by severity of TR and whether or not they underwent concomitant tricuspid intervention. Operative morbidity and mortality were compared between the 2 groups. Further analysis was performed using propensity score–matched pairs.
Among 17,483 patients undergoing AVR, 8984 (51%) had no TR, 7252 (41%) had mild TR, 1060 (6%) had moderate TR, and 187 (1%) had severe TR. Overall, more severe TR was associated with higher morbidity and mortality. Tricuspid intervention was performed in 104 patients (0.6%), including 0.2% of patients with mild TR, 2% of those with moderate TR, and 31% of those with severe TR. In the propensity score–matched analysis, there was not a statistically significant difference in operative mortality between the 2 groups (18% vs 9%; P = .16), but there was significantly higher composite major morbidity (51% vs 26%; P = .006) in the tricuspid intervention group compared with those without surgical TR correction.
Increasing severity of TR is associated with higher rates of morbidity and mortality after AVR. Correction of TR at the time of surgical AVR is not associated with increased operative mortality and has been shown to improve long-term outcomes.
Retrospective review detailing the incidence of tricuspid regurgitation in patients undergoing aortic valve replacement, the rate of concomitant tricuspid intervention, and surgical outcomes compared among propensity score–matched patients who underwent aortic valve replacement with and without concomitant tricuspid surgery. [Display omitted]