Severity of tricuspid regurgitation is associated with long-term mortality

Brian J Kelly, Jamahal Maeng Ho Luxford, Carolyn Goldberg Butler, Chuan-Chin Huang, Kerry Wilusz, Julius I Ejiofor, James D Rawn, John A Fox, Stanton K Shernan, Jochen Daniel Muehlschlegel, Brian J Kelly, Jamahal Maeng Ho Luxford, Carolyn Goldberg Butler, Chuan-Chin Huang, Kerry Wilusz, Julius I Ejiofor, James D Rawn, John A Fox, Stanton K Shernan, Jochen Daniel Muehlschlegel

Abstract

Objectives: To determine the association between intraoperative/presurgical grade of tricuspid regurgitation (TR) and mortality, and to determine whether surgical correction of TR correlated with an increased chance of survival compared with patients with uncorrected TR.

Methods: The grade of TR assessed by intraoperative transesophageal echocardiography (TEE) before surgical intervention was reviewed for 23,685 cardiac surgery patients between 1990 and 2014. Cox proportional hazard regression models were used to determine association between grade of TR and the primary endpoint of all-cause mortality. Association between tricuspid valve (TV) surgery and survival was determined with Cox proportional hazard regression models after matching for grade of TR.

Results: Kaplan-Meier survival curves demonstrated a relationship between all grades of TR. Multivariable analysis of the entire cohort demonstrated significantly increased mortality for moderate (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.1-1.4; P < .0001) and severe TR (HR, 2.02; 95% CI, 1.57-2.6; P < .0001). Mild TR displayed a trend for mortality (HR, 1.07; 95% CI, 0.99-1.16; P = .075). After matching for grade of TR and additional confounders, patients who underwent TV surgery had a statistically significant increased likelihood of survival (HR, 0.74; 95% CI, 0.61-0.91; P = .004).

Conclusions: Our study of more than 20,000 patients demonstrates that grade of TR is associated with increased risk of mortality after cardiac surgery. In addition, all patients who underwent TV surgery had a statistically significantly increased likelihood of survival compared with those with the same degree of TR who did not undergo TV surgery.

Keywords: coronary artery bypass grafting; mortality; surgery; transesophageal echocardiography; tricuspid regurgitation; tricuspid valve.

Conflict of interest statement

The authors declare no competing interests.

Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Kaplan-Meier curve of grade of tricuspid regurgitation and all-cause mortality.
Figure 2
Figure 2
Kaplan-Meier curve of matched patients with and without tricuspid valve surgery and all-cause mortality.
Figure 2
Figure 2
Kaplan-Meier curve of matched patients with and without tricuspid valve surgery and all-cause mortality.
Video 1
Video 1
Video of the authors discussing the relevance of tricuspid regurgitation in the cardiac surgery patient population and the findings of this study.

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