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Determinants of clinical outcomes of surgery for isolated severe tricuspid regurgitation

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Abstract
Objectives Although the incidence of patients with isolated tricuspid regurgitation (TR) is increasing, data regarding the clinical outcomes of isolated TR surgery are limited. This study sought to investigate the prognostic implications according to procedural types, and to identify preoperative predictors of clinical outcomes after isolated TR surgery.

Methods Among consecutive 2610 patients receiving tricuspid valve (TV) procedure, we analysed 238 patients (age, 59.6 years; 143 females) who underwent stand-alone TV surgery (repair, 132; replacement, 106) for severe TR. Primary outcome was the composite of all-cause mortality and heart transplantation. Clinical outcomes between the repair and the replacement groups were compared after adjusting with the inverse probability of treatment weighting (IPTW) method.

Results During follow-up (median, 4.1 years), 53 patients died and 4 received heart transplantation. Multivariable analysis revealed that age (p=0.001), haemoglobin level (p=0.003), total bilirubin (p=0.040), TR jet area (p=0.005) and right atrial (RA) pressure (p=0.022) were independent predictors of the primary outcome. After IPTW adjustment, there were no significant intergroup differences in the risk of primary outcome (HR 1.01; 95% CI 0.55 to 1.87). In the subgroup analysis, tricuspid annular diameter was identified as a significant effect modifier (p=0.012) in the comparison between repair versus replacement, showing a trend favouring replacement in patients with annular diameter >44 mm.

Conclusions The outcomes of stand-alone severe TR surgery were independently associated with the severity of TR and RA pressure. In selected patients with severe annular dilation >44 mm, replacement may become a feasible option.
Author(s)
박성준오진경김선옥이승아김호진이사민정성호송종민주석중강덕현정철현송재관이재원김대희김준범
Issued Date
2021
Type
Article
Keyword
Abridged Index MedicusCardiac arrhythmiaCardiovascular diseaseClinical outcomesHeart failureHeart surgeryHemoglobinLaboratoriesMedical prognosisMedical recordsMortalityPatientsPulmonary arteriesStatistical analysis
DOI
10.1136/heartjnl-2020-317715
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8757
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2457275812&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Determinants%20of%20clinical%20outcomes%20of%20surgery%20for%20isolated%20severe%20tricuspid%20regurgitation&offset=0&pcAvailability=true
Publisher
HEART
Location
영국
Language
영어
ISSN
1355-6037
Citation Volume
107
Citation Number
5
Citation Start Page
403
Citation End Page
410
Appears in Collections:
Medicine > Medicine
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