PMID- 28841733
OWN - NLM
STAT- MEDLINE
DCOM- 20180822
LR  - 20201216
IS  - 1439-1902 (Electronic)
IS  - 0171-6425 (Linking)
VI  - 65
IP  - 8
DP  - 2017 Dec
TI  - Comparison of Outcomes of Tricuspid Valve Surgery in Patients with Reduced and 
      Normal Right Ventricular Function.
PG  - 617-625
LID - 10.1055/s-0037-1604450 [doi]
AB  - BACKGROUND: To study the effect of tricuspid valve repair/replacement on outcomes 
      of patients with reduced systolic right ventricular function. METHODS: Between 
      January 2012 and July 2016, 191 patients with isolated tricuspid valve 
      regurgitation and/or in combination with other valve diseases were enrolled into 
      this retrospective study. We compared early postoperative outcomes (i.e., 30 days 
      after surgery) between patients' cohort with a preoperative reduced (i.e., at 
      least moderately) versus normal (or mildly reduced) right ventricular function as 
      defined by means of preoperative echocardiography. RESULTS: A total of 82 (43%) 
      patients had preoperatively reduced right ventricle function with tricuspid 
      annular plane systolic excursion (TAPSE) of 13.3 +/- 3.3 versus 20.2 +/- 4.9 mm 
      (p < 0.001). Ring annuloplasty was the most common surgical technique (i.e., 91% 
      in both groups). Time of procedure (317 +/- 123 vs. 262 +/- 88 minutes, p < 0.01) and 
      time on cardiopulmonary bypass (163 +/- 77 vs. 143 +/- 57 minutes, p = 0.036) were 
      significantly longer in patients with impaired right ventricular function. 
      Postoperative lactate (3.5 +/- 3 vs. 2 +/- 1 mmol/L, p = 0.001) and dose of 
      catecholamines (epinephrine, 0.07 +/- 0.15 vs. 0.013 +/- 0.02 microg/kg/min, p = 0.001; 
      norepinephrine, 0.18 +/- 0.23 vs. 0.07 +/- 0.09 microg/kg/min, p = 0.007) were also 
      higher in this group. Postoperative rate of low cardiac output syndrome (10 vs. 
      27%, p = 0.005) and early mortality (n = 2 vs. n = 9, p = 0.018) were 
      significantly increased in patients with reduced right ventricular function. 
      Previous cardiac operation (p = 0.045), preoperative higher number of acute 
      decompensations of heart failure (p < 0.001), reduced right ventricular function 
      (p = 0.018), postoperative low cardiac output syndrome (p < 0.001), and renal 
      replacement therapy (p < 0.001) were identified as risk factors for early 
      mortality. Echocardiography at discharge revealed tricuspid valve regurgitation 
      grade of 0.9 +/- 0.7 versus 0.7 +/- 0.6 (p = 0.052) and TAPSE of 12 +/- 3 versus 
      15 +/- 5 mm (p = 0.026) in patients with reduced right ventricular function. The 
      New York Heart Association (NYHA) class improved to 1.7 +/- 0.7 versus 1.3 +/- 1 
      (p < 0.001) in this group of patients. CONCLUSION: Tricuspid valve 
      repair/replacement effectively eliminated severe tricuspid regurgitation and 
      improved clinical signs of heart failure. Although mortality and morbidity were 
      increased in the group with reduced right ventricular function, even these 
      patients benefitted from improved functional status and right ventricular 
      systolic function early postoperatively.
FAU - Subbotina, Irina
AU  - Subbotina I
AD  - Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany.
FAU - Girdauskas, Evaldas
AU  - Girdauskas E
AD  - Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany.
FAU - Bernhardt, Alexander M
AU  - Bernhardt AM
AD  - Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany.
FAU - Sinning, Christoph
AU  - Sinning C
AD  - Department of General and Interventional Cardiology Surgery, University Heart 
      Center Hamburg, Germany.
FAU - Reichenspurner, Hermann
AU  - Reichenspurner H
AD  - Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany.
FAU - Sill, Bjoern
AU  - Sill B
AD  - Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20170825
PL  - Germany
TA  - Thorac Cardiovasc Surg
JT  - The Thoracic and cardiovascular surgeon
JID - 7903387
SB  - IM
MH  - Aged
MH  - Cardiac Surgical Procedures/*methods
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Ventricles/diagnostic imaging/*surgery
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Systole
MH  - Time Factors
MH  - Treatment Outcome
MH  - Tricuspid Valve/diagnostic imaging/*surgery
MH  - Tricuspid Valve Insufficiency/diagnosis/physiopathology/*surgery
MH  - Ventricular Function, Right/*physiology
COIS- Disclosure The authors report no conflicts of interest in this work.
EDAT- 2017/08/26 06:00
MHDA- 2018/08/23 06:00
CRDT- 2017/08/26 06:00
PHST- 2017/08/26 06:00 [pubmed]
PHST- 2018/08/23 06:00 [medline]
PHST- 2017/08/26 06:00 [entrez]
AID - 10.1055/s-0037-1604450 [doi]
PST - ppublish
SO  - Thorac Cardiovasc Surg. 2017 Dec;65(8):617-625. doi: 10.1055/s-0037-1604450. Epub 
      2017 Aug 25.