Determinants of Clinical Outcomes of Surgery for Isolated Severe Tricuspid Regurgitation

¹Sung Jun Park, ²⁴Jin Kyung Oh, ³Seon Ok Kim, ²Seung-Ah Lee, ¹Ho Jin Kim, ²Sahmin Lee, ¹Sung-Ho Jung, ²Jong-Min Song, ¹Suk Jung Choo, ²Duk-Hyun Kang, ¹Cheol Hyun Chung, ²Jae-Kwan Song, ¹Jae Won Lee, ²Dae-Hee Kim, ¹Joon Bum Kim

¹Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea ²Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea ³Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea ⁴Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Daejeon, Korea

Purpose : 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 2,610 patients receiving tricuspid valve (TV) procedure, we analyzed 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, 4.1yrs), 53 patients died and 4 received heart transplantation. Multivariable analysis revealed that age (p=0.001), hemoglobin level (p=0.011), TR jet area (p=0.010), and right atrial (RA) pressure (p=0.014) were independent predictors of the primary outcome. After IPTW-adjustment, there were no significant intergroup
differences in the risk of primary outcome (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.55–1.87). In the subgroup analysis, tricuspid annular diameter was identified as a significant effect modifier (p=0.012) in the comparison between repair vs. replacement, showing a trend favoring replacement in patients with annular diameter>44mm.

Conclusion : 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 greater than 44 mm, replacement may become a feasible option.

책임저자: Joon Bum Kim

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

발표자: Sung Jun Park, E-mail : sungjun0919@naver.com