Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2017; 9(10): 787-793
Published online Oct 26, 2017. doi: 10.4330/wjc.v9.i10.787
Clinical outcomes of tricuspid valve repair accompanying left-sided heart disease
Kasra Azarnoush, Ahmad S Nadeemy, Bruno Pereira, Massoud A Leesar, Céline Lambert, Alaa Azhari, Vedat Eljezi, Nicolas Dauphin, Etienne Geoffroy, Lionel Camilleri
Kasra Azarnoush, INRA, UMR 1019 Nutrition Humaine, 63122 Saint Genès Champanelle, France
Kasra Azarnoush, Alaa Azhari, Vedat Eljezi, Nicolas Dauphin, Etienne Geoffroy, Lionel Camilleri, Department of Cardiac Surgery, CHU Gabriel Montpied, 63003 Clermont-Ferrand, France
Ahmad S Nadeemy, Kabul Medical University Heart Disease Institute, Kabul, Afghanistan
Bruno Pereira, Céline Lambert, Biostatistics Unit, CHU Gabriel Montpied, 63003 Clermont-Ferrand, France
Massoud A Leesar, Interventional Cardiology, University of Alabama, Birmingham, AL 35233, United States
Author contributions: Azarnoush K and Nadeemy AS designed and performed the research and wrote the paper; Pereira B and Lambert C did the statistic and data evaluation; Dauphin N and Geoffroy E performed all echocardiography concerning study patients; Leesar MA, Azhari A, Eljezi V and Camilleri L supervised the report and the manuscript and gave the final approval.
Institutional review board statement: The study was reviewed and approved by the Clermont-Ferrand University Hospital research unit, the “Délégation à la Recherche Clinique et à l'Innovation (DRCI)” and all statistical analyses were overseen by an independent Biostatistics unit.
Informed consent statement: All involved persons (subjects or legally authorized representative) gave their informed consent (written or verbal, as appropriate) prior to study inclusion.
Conflict-of-interest statement: All authors declare having no conflicts of interest.
Data sharing statement: The statistical methods and original anonymous dataset are available on request from the corresponding author at kazarnoush@chu-clermontferrand.fr.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kasra Azarnoush, MD, PhD, Department of Cardiac Surgery, CHU Gabriel Montpied, 58 Rue Montalembert, BP 69, 63003 Clermont-Ferrand, France. kazarnoush@chu-clermontferrand.fr
Telephone: +33-47-3751577 Fax: +33-47-3751579
Received: October 27, 2016
Peer-review started: October 31, 2016
First decision: January 14, 2017
Revised: May 12, 2017
Accepted: May 22, 2017
Article in press: May 23, 2017
Published online: October 26, 2017
Processing time: 214 Days and 10.5 Hours
Abstract
AIM

To determine whether the need for additional tricuspid valve repair is an independent risk factor when surgery is required for a left-sided heart disease.

METHODS

One hundred and eighty patients (68 ± 12 years, 79 males) underwent tricuspid annuoplasty. Cox proportional-hazards regression model for multivariate analysis was performed for variables found significant in univariate analyses.

RESULTS

Tricuspid regurgitation etiology was functional in 154 cases (86%), organic in 16 cases (9%), and mixed in 10 cases (6%), respectively. Postoperative mortality at 30 days was 11.7%. Mean follow-up was 51.7 mo with survival at 5 years of 73.5%. Risk factors for mortality were acute endocarditis [hazard ratio (HR) = 9.22 (95%CI: 2.87-29.62), P < 0.001], ischemic heart disease requiring myocardial revascularization [HR = 2.79 (1.26-6.20), P = 0.012], and aortic valve stenosis [HR = 2.6 (1.15-5.85), P = 0.021]. Significant predictive factors from univariate analyses were double-valve replacement combined with tricuspid annuloplasty [HR = 2.21 (1.11-4.39), P = 0.003] and preoperatively impaired ejection fraction [HR = 1.98 (1.04-3.92), P = 0.044]. However, successful mitral valve repair showed a protective effect [HR = 0.32 (0.10-0.98), P = 0.046]. Additionally, in instances where tricuspid regurgitation required the need for concomitant tricuspid valve repair, mortality predictor scores such as Euroscore 2 could be shortened to a simple Euroscore-tricuspid comprised of only 7 inputs. The explanation may lie in the fact that significant tricuspid regurgitation following left-sided heart disease represents an independent risk factor encompassing several other factors such as pulmonary arterial hypertension and dyspnea.

CONCLUSION

Tricuspid annuloplasty should be used more often as a concomitant procedure in the presence of relevant tricuspid regurgitation, although it usually reveals an overly delayed correction of a left-sided heart disease.

Keywords: Tricuspid regurgitation, Patient outcome assessment, Valvular annuloplasty, Infective endocarditis, Mitral valve annuloplasty

Core tip: Tricuspid valve repair with flexible ring is easy to achieve in patients undergoing heart surgery. Predictor scores such as Euroscore 2 could be shortened to a simple Euroscore-tricuspid of only 7 inputs. A significant tricuspid regurgitation following a left-sided heart disease is an independent risk factor that encompasses several other factors such as pulmonary arterial hypertension and dyspnea. Patients with functional damage of the right side of the heart and significant functional tricuspid regurgitation have poor mid-term results with high mortality. A concomitant tricuspid regurgitation usually reveals a delayed correction of a left-sided heart disease.