Impact of pulmonary hypertension and right ventricular function on outcomes of isolated tricuspid valve surgeryCentral MessagePerspective
Salah E. Altarabsheh, MD,
Juan A. Crestanello, MD,
Nishant Saran, MD,
Richard C. Daly, MD,
Joseph A. Dearani, MD,
Kevin L. Greason, MD,
John M. Stulak, MD,
Austin Todd, MS,
Phillip G. Rowse, MD,
Arman Arghami, MD,
Gabor Bagameri, MD,
Mauricio A. Villavicencio, MD,
Hartzell V. Schaff, MD,
Vidhu Anand, MBBS
Affiliations
Salah E. Altarabsheh, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Juan A. Crestanello, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Nishant Saran, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Richard C. Daly, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Joseph A. Dearani, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Kevin L. Greason, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
John M. Stulak, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Austin Todd, MS
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minn
Phillip G. Rowse, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Arman Arghami, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Gabor Bagameri, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Mauricio A. Villavicencio, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Hartzell V. Schaff, MD
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Vidhu Anand, MBBS
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn; Address for reprints: Vidhu Anand, MBBS, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, 200 First St SW, Rochester, MN 55905.
Objective: To evaluate the impact of pulmonary hypertension and right ventricular dysfunction on outcomes of isolated tricuspid valve surgery. Methods: From 2004 to 2022, 298 patients (age 71.0 ± years, 59.4% female) underwent isolated tricuspid valve surgery. Pulmonary hypertension was defined as right ventricular systolic pressure ≥50 mm Hg, and right ventricular dysfunction as right ventricular fractional area change <32% on preoperative transthoracic echocardiogram. Patients were stratified into 4 groups: group I: No pulmonary hypertension or right ventricular dysfunction (n = 199), group II: pulmonary hypertension without right ventricular dysfunction (n = 45), group III: right ventricular dysfunction without pulmonary hypertension (n = 43), and group IV: pulmonary hypertension and right ventricular dysfunction (n = 11). Uni- and multivariable analyses were performed to evaluate association of pulmonary hypertension and right ventricular function with outcomes. Results: Tricuspid valve replacement was performed in 218 (73.2%) and repair in 80 (26.8%) patients. Operative mortality was 4.7%, similar for reoperations (5.2%) and primary procedures (4.5%) (P = .907). Median follow-up was 5.4 (interquartile range, 2.3-12.5) years, survival was 74.4%, 48.4%, 39.8%, and 67.3% in groups I-IV, respectively (P < .0001). Multivariable analysis identified pulmonary hypertension (hazard ratio, 2.9; 1.83-4.62, P < .001) and right ventricular dysfunction (hazard ratio, 2.83; 1.76-4.56, P < .001) as independent predictors of greater long-term all-cause mortality, in addition to older age (P < .001) and severe chronic lung disease (P < .001). Conclusions: Among patients who underwent isolated tricuspid valve surgery, presence of pulmonary hypertension or right ventricular dysfunction at baseline is linked to greater long-term mortality.
