Combined Valve Operations in the Aortic and Mitral Positions With or Without Added Tricuspid Valve Repair

There is limited clinical evidence on when to address tricuspid regurgitation in patients with aortic and mitral valve disease requiring surgical intervention. In this study, we aimed to investigate the potential added value of performing a tricuspid valve repair concomitantly in patients requiring...

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Bibliographic Details
Published in:Seminars in thoracic and cardiovascular surgery 2020-01, Vol.32 (4), p.665-672
Main Authors: Faggion Vinholo, Thais, Mori, Makoto, Mahmood, Syed Usman Bin, Mullan, Clancy W., Weininger, Gabe, Yousef, Sameh, Geirsson, Arnar
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic Valve - diagnostic imaging
Aortic Valve - physiopathology
Aortic Valve - surgery
Cardiac Surgical Procedures - adverse effects
Female
Heart Valve Diseases - diagnostic imaging
Heart Valve Diseases - physiopathology
Heart Valve Diseases - surgery
Hemodynamics
Humans
Male
Middle Aged
Mitral Valve - diagnostic imaging
Mitral Valve - physiopathology
Mitral Valve - surgery
Multiple valve surgery
Postoperative Complications - etiology
Recovery of Function
Retrospective Studies
Risk Factors
Treatment Outcome
Tricuspid valve
Tricuspid Valve - diagnostic imaging
Tricuspid Valve - physiopathology
Tricuspid Valve - surgery
Triple valve surgery
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Summary:There is limited clinical evidence on when to address tricuspid regurgitation in patients with aortic and mitral valve disease requiring surgical intervention. In this study, we aimed to investigate the potential added value of performing a tricuspid valve repair concomitantly in patients requiring double valve surgery (DVS) of the aortic and mitral valves. We reviewed 223 cases of multivalve surgery from 2011 to 2016. In this single-institution series, 190 underwent DVS in aortic and mitral positions and 33 had triple valve surgery in aortic, mitral, and tricuspid positions. Preoperative and postoperative echocardiograms were evaluated to determine changes in valve function. A logistic regression model was performed to assess relationship of patient comorbidities and type of valve operations to perioperative adverse events. Mid-term survival was similar between the 2 groups (P = 0.541). Compared to DVS, TVS was not associated with an increased risk of perioperative adverse events, including need for pacemaker or mortality on multivariable analysis. Within the DVS subgroup, 19.8% of patients experienced improvement in tricuspid valve function with decrease in the degree of tricuspid regurgitation within a 6-month postoperative follow-up. Our study indicates that repairing the tricuspid valve while addressing the aortic and mitral valves does not pose significant additional risk. The observed improvement of the degree of tricuspid regurgitation without tricuspid operation suggests the need to further define subpopulations of patients with multivalvular disease. Tricuspid valve repair while addressing the aortic and mitral valve was not associated with increased risk indicating the safety of performing triple valve surgery. There is a fraction of patients within the DVS group who experienced TR improvement. TR, tricuspid regurgitation; DVS, double valve surgery. [Display omitted]
ISSN:1043-0679
1532-9488
DOI:10.1053/j.semtcvs.2020.02.010