Outcome and determinants of prognosis in patients undergoing isolated tricuspid valve surgery

Background: Although tricuspid valve (TV) surgery has become more popular, isolated TV surgery is infrequently performed. The aims of this study were (1) to evaluate the postoperative and long-term mortality of patients undergoing isolated TV surgery, (2) to compare the outcomes of patients undergoing their first TV surgery or TV reoperation, and (3) to assess the additive value of echocardiographic and invasive hemodynamic evaluations for predicting postoperative outcome. Methods and results: We followed a contemporary cohort of patients undergoing isolated TV surgery from January 1, 1995, through December 31, 2011. Preoperative demographic, echocardiographic, hemodynamic, and operative data were included. Outcome was all-cause mortality. We compared the outcomes of patients undergoing their first TV surgery (n=61) with those undergoing TV reoperation (n=31). Ninety-two patients (38% male; mean age: 56±14 years) were included. Kaplan-Meier survival analyses showed that 30-day, 3-month, 5-year, and 10-year mortality were 7.9%, 15.2%, 25.7%, and 53.7%, respectively. Mortality of the two groups of patients did not differ (log-rank test, p=0.339). Univariate Cox proportional hazards analysis identified age (p<0.0001), extracardiac vascular disease (p=0.001), glomerular filtration rate (p=0.022), NYHA classification (p=0.001), and pulmonary hypertension (p=0.005) as predictors of mortality. In younger patients (<59 years), NYHA classification and pulmonary hypertension were the only determinants of mortality (p=0.021; HR 6.716 [1.327-33.992]). ![Figure][1] Conclusions: Isolated TV surgery is still associated with significant postoperative and long-term mortality. Pre-operative NYHA functional class and pulmonary hypertension in younger patients appear to determine prognosis. [1]: pending:yes