Predictors of Long-term Outcomes in Patients Undergoing Tricuspid Valve Surgery with Right Ventricular Failure

Abstract

Objective: To investigate and identify the prognostic indicators of cardiac surgical outcomes in patients with pulmonary hypertension (PH) with or without right ventricle (RV) dysfunction. Methods: In this retrospective observational study, all the patients with preoperative PH who underwent isolated mitral valve and tricuspid valve surgery from May 2011 to December 2019, were enrolled in the study (n=80, age 66.7±13.4 yo). This cohort was then classified as Group 1 (RV dysfunction; n=27, 34%) and Group 2 (RV normal; n=53, 66%), according to the function of the RV. PH was defined as a mean pulmonary arterial pressure (mPAP)≥25mmHg, or pulmonary artery systolic pressure (PASP)≥38mmHg. RV dysfunction was defined based on American Society of Echocardiography guidelines. Results: The cumulative mortality at 30 days was 11% (n=9) with no statistical difference between the two groups (Group 1: n=4, 15%; Group 2: n=5, 9%; x2= 1.23, p=0.266). Instead, a significant difference in the mortality rate was observed between the type of surgery performed: mitral valve replacement and tricuspid valve repair was associated with higher mortality rate (n=8, 23%; x2= 7.01, p=0.030) when compared with mitral repair. In univariate analysis, RV dysfunction was correlated with a lower ejection fraction (61.4±10 vs 55.6±10, p=0.017), higher incidence of respiratory failure (OR:9; CI:0.9-85; p=0.042) and higher length of stay (median 8 days (IQR:1-25), p=0.042). The type of surgery was a predictor risk in a Cox regression analysis (Hazard ratio: 0.08; CI:0.01-0.7; p=0.022). Conclusions: In patients with PH and/or RV dysfunction, mitral valve replacement alone represents an independent risk factor for mortality, irrespective of the aetiology. RV dysfunction is related to longer length of stay and incidences of peri-operative morbidity.