Tricuspid surgery at time of mitral surgery improves survival free from severe tricuspid regurgitation but not quality of lifeCentral MessagePerspective
Noah Weingarten, MD,
Amit Iyengar, MD,
Cindy Song, BA,
David Rekhtman, BS,
Nikhil Ganjoo, BA,
Sharon Lee, BA,
Chaitanya Karimanasseri,
Mark Helmers, MD,
Mrinal Patel, MCh,
David Alan Herbst, MD,
John James Kelly, MD,
Pavan Atluri, MD
Affiliations
Noah Weingarten, MD
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
Amit Iyengar, MD
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
Cindy Song, BA
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
David Rekhtman, BS
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
Nikhil Ganjoo, BA
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
Sharon Lee, BA
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
Chaitanya Karimanasseri
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
Mark Helmers, MD
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
Mrinal Patel, MCh
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
David Alan Herbst, MD
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
John James Kelly, MD
Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
Pavan Atluri, MD
Address for reprints: Pavan Atluri, MD, Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, 3400 Spruce St, Philadelphia, PA 19104.; Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
Objective: The choice to operate on moderate tricuspid regurgitation (TR) during mitral surgery is challenging owing to limited mid-term data. We assess whether concomitant tricuspid operations improve mid-term quality of life, morbidity, or mortality. Methods: An institutional database identified mitral surgery recipients with moderate TR at the time of surgery from 2010 to 2019. Patients were stratified by the presence of a concomitant tricuspid operation. Quality of life at the last follow-up was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Morbidity was compared using the χ2 test, Mann-Whitney U test, and Student t test. Survival was analyzed with Kaplan-Meier estimation. Results: Of 210 mitral surgery recipients, 67 (31.9%) underwent concomitant tricuspid surgery. The concomitant tricuspid surgery cohort had greater preoperative dialysis use (10.5% vs 3.5%; P = .043) but similar age, New York Heart Association class, and cardiac surgery history relative to the nonconcomitant cohort (P > .05 for all). The concomitant tricuspid surgery cohort had a longer cardiopulmonary bypass time (144 minutes vs 122 minutes; P = .005) but a similar rate of mitral repair (P = .220). Postoperative KCCQ-12 scores reflected high quality of life in both cohorts (95.1 vs 89.1; P = .167). The concomitant tricuspid surgery cohort trended toward a higher perioperative pacemaker placement rate (22.8% vs 12.7%; P = .088) but were less likely to develop severe TR (0.0% vs 13.0%; P = .004). Overall survival was comparable between the 2 cohorts at 1 year (84.9% vs 81.6%; P = .628) and 5 years (73.5% vs 57.9%; P = .078). Five-year survival free from severe TR was higher in the concomitant cohort (73.5% vs 54.3%; P = .032). Conclusions: Concomitant tricuspid surgery for moderate TR is associated with increased 5-year survival free from severe TR but not with increased quality of life.
