Beating Versus Arrested Heart Isolated Tricuspid Valve Surgery: Long-term Outcomes
- Marco Russo1
- Michele Di Mauro2
- Guglielmo Saitto3
- Antonio Lio3
- Paolo Berretta4
- Maurizio Taramasso5
- Roberto Scrofani6
- Alessandro Della Corte7
- Sandro Sponga8
- Ernesto Greco9
- Matteo Saccocci10
- Antonio Calafiore11
- Giacomo Bianchi12
- Dror B Leviner13
- Andrea Biondi14
- Ester Della Ratta7
- Ugolino Livi8
- Erez Sharoni13
- Paul Werner15
- Carlo De Vincentiis14
- Marco Di Eusanio4
- Alfred Kocher15
- Carlo Antona6
- Fabio Miraldi9
- Giovanni Troise10
- Marco Solinas12
- Francesco Maisano5
- Guenther Laufer15
- Francesco Musumeci16
- Martin Andreas15
- 1. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy. Electronic address: mar.russo1987@gmail.com.
- 2. Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
- 3. Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy; Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
- 4. Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy.
- 5. Cardiac Surgery Department, University Heart Center of Zurich, Zurich, Switzerland.
- 6. Cardiac Surgery Unit, Ospedale Fatenefratelli Sacco, Milano, Italy.
- 7. Department of Translational Medical Sciences, University of Campania "L. Vanvitelli," Unit of Cardiac Surgery, V Monaldi Hospital, Neaples, Italy.
- 8. Cardiac Surgery Unit, University Hospital of Udine, Udine, Italy.
- 9. Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University, Rome, Italy.
- 10. Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy.
- 11. Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
- 12. Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy.
- 13. Carmel Medical Center, Haifa, Israel.
- 14. Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
- 15. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
- 16. Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy.
Description
Russo M, Di Mauro M, Saitto G, Lio A, Berretta P, Taramasso M, Scrofani R, Della Corte A, Sponga S, Greco E, Saccocci M, Calafiore A, Bianchi G, Leviner DB, Biondi A, Della Ratta E, Livi U, Sharoni E, Werner P, De Vincentiis C, Di Eusanio M, Kocher A, Antona C, Miraldi F, Troise G, Solinas M, Maisano F, Laufer G, Musumeci F, Andreas M. Beating Versus Arrested Heart Isolated Tricuspid Valve Surgery: Long-term Outcomes. Ann Thorac Surg. 2022 Feb;113(2):585-592. doi: 10.1016/j.athoracsur.2021.03.070. Epub 2021 Apr 5. PMID: 33831392.
Abstract
Background: Isolated tricuspid valve (TV) surgery is a rare procedure generally considered at high risk for perioperative mortality and poor long-term outcomes. Surgical treatment can be performed with either an arrested heart (AH) or beating heart (BH) technique. The aim of this study was to compare the outcomes of isolated tricuspid surgery with 2 different approaches.
Methods: The Surgical-Tricuspid Study is a multicenter international retrospective study enrolling adult patients who underwent isolated TV procedures (n = 406; age 56 ± 16 years; 56% female) at 13 international sites. The AH and BH strategies were performed in 253 and 153 patients, respectively. Propensity score-matched analysis was used to compare groups.
Results: After matching, 129 pairs were obtained and analyzed. The 30-day mortality rate was 6.2% versus 5.0% in the AH and BH groups, respectively (P = .9). The rates of acute renal failure requiring replacement therapy (10% versus 3%; P = .02) and stroke (1.6% versus 0%; P = .08) were numerically higher in the AH group. The 6-year survival rate was 67% ± 6% versus 78% ± 5% in the AH and BH groups, respectively (P = .18), whereas freedom from cardiac death was 75% ± 5% versus 84% ± 4% (P = .21). The 6-year composite cardiac end point of cardiac death and reoperation rate was 60% ± 9% versus 86% ± 5% (P = .024) comparing AH-TV replacement and BH-TV repair groups.
Conclusions: Isolated TV surgery performed with a BH strategy is a safe option and resulted in a trend of increased long-term survival and freedom from reoperation compared with the standard AH technique. Patients undergoing BH valve repair had the best long-term outcome.
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