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P34
Single Center Experience with all Aspects of Tricuspid Valve Surgery, Including Long-term Outcomes

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Purpose

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Evaluation of tricuspid valve surgery (TVS) is rare outside of the association with mitral valve surgery (MVS), where recent data shows no impact on early and long-term mortality. We hypothesized that contrary to the prognostic of mitro-tricuspid situation, TVS has a more severe early and long-term prognosis.

Methods

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From 2008 to 2015, we performed a series of 315 consecutive TVS procedures, 23 (ITV) as an isolated procedure, 36 combined aorto-tricuspid surgeries (ATV), 60 triple valve operations (TVO) and 196 mitro-tricuspid (MTV) procedures with various degrees of tricuspid regurgitation (TR) based on clinical, echographic and hemodynamic assessment. Additional concomitant coronary bypass procedures were performed in 109 cases (38.09%). Prospectively collected data were reviewed from our STS database and hemodynamic files. Main baseline variables are depicted in Table I by interventions, pooling together “other than mitro-tricuspid procedures” (OMT) for presentation purposes. Social Security database query provided long-term follow-up information.

 

Results

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Concomitant coronary bypass procedures were performed in 47.90% of patients with OMT procedures vs. 32.14% after MVT (p= 0.005) and aortic regurgitation grade ≥2 was present in 44.6 % of OMT vs. 18.87% after MTV procedures (p<0.01). Early morbidity was not statistically different between the two populations, with identical rates of major complications. Early (30-day) mortality was significantly higher after OMT (globally 10.92% vs. 3.06% after MTV surgery, p=). By sub-group, early mortality was 4.53% after ITV, 5.56% after ATV and .16.67% after TVO procedures. Post-operative mean follow-up was shorter after OMT (27.35 months) than after MTV (33 months, p=0.023). Cumulative probability of survival at 5 years (Kaplan-Meier, Fig.1) was 77.51 % for MTV patients and 48.35% for patients receiving TVS either isolated or associated with other than mitral surgery (Log-Rank test, p = .00092). Comparatively, individual 5-year survival was 47.86% after ITV, 45.98% after ATV, and 52.40% after TVO procedures, respectively.

 

Conclusions

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TVS when associated with MVS has low and early and late (5-year) mortality, not different from isolated MVS as previously reported. However, when performed as an isolated procedure or associated with aortic valve or part of a triple valve procedure, early and late mortality risks increase significantly.

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