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The Journal of Cardiovascular Surgery 2021 Sep 14

DOI: 10.23736/S0021-9509.21.12064-6


language: English

Is the pulmonary pressure directly correlated with the operative risk in patients with isolated tricuspid valve surgery?

Bettina PFANNMUELLER 1 , Luca-Marie BUDDE 1, Thilo NOACK 1, Mateo MARIN-CUARTAS 1, Martin MISFELD 1, 2, 3, Michael A. BORGER 1

1 University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; 2 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; 3 The Discipline of Medicine, The Central Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia


BACKGROUND: Severe pulmonary hypertension is a relative contraindication for isolated tricuspid valve (TV) surgery. However, some patients may still benefit from TV surgery. We hypothesized that pulmonary pressure alone is an inadequate predictor of outcomes post-TV surgery, and that aorto-pulmonary pressure quotient (AoP/PAP) is a better predictor.
METHODS: From 2005 to 2019, a total of 122 patients (mean age: 68.5±10.5 years; 43.3% male) with isolated TV regurgitation and preoperative right heart catheterization referred to our institution for isolated TV surgery were included. Patients with concomitant procedures were excluded from this analysis. All data were retrospectively analyzed. Follow-up was 97% complete.
RESULTS: The mean follow-up time was 4.3±3.6 years. The mean preoperative New York Heart Association (NYHA) class was 2.9±0.7, left ventricular ejection fraction was 52.3±11.3%, creatinine level was 124.8±102.6μmol/l, mean pulmonary artery pressure was 25.5±9.4mmHg, mean MELD-XI score 13.5±4.2, and mean AoP/PAP was 4.1±1.9 mmHg. Thirty-day mortality was 10.9%, and 5-years survival was 56.6±4.9%. Cox regression analysis revealed age (p=0.001; HR: 1.058; CI 95%: 1.023-1.094), the mean arterial pressure (p=0.002; HR: 0.969; CI 95%: 0.950-0.988) and systolic pulmonary artery pressure (p=0.035; HR: 1.054; CI 95%: 1.004-1.107), as well as mean AoP/PAP > 4 (p=0.001; HR: 6.678; CI 95%: 2.197-20.294) as predictors for long-term mortality.
CONCLUSIONS: Regardless of the degree of pulmonary hypertension, a mean AoP/PaP quotient >4 impacts the postoperative survival of patients undergoing isolated TV surgery. However, further research is still required to verify this finding.

KEY WORDS: Tricuspid valve surgery; Pulmonary hypertension; Aorto-pulmonary pressure quotient; Tricuspid regurgitation

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