Predictor for Operative Risk in Patients with Reoperative Isolated Tricuspid Valve Surgery

Objectives: Reoperative isolated tricuspid valve (TV) surgery is considered as a high risk procedure. The purpose of this study was to evaluate risk factors for mortality after redo TV-surgery.

Methods: From January 2005 to January 2019, a total of 98 patients with isolated TV regurgitation and prior cardiac surgery were referred to our institution for TV operation. The mean age of the patients was 66.0 ± 10.9 years, 61 patients (62.2%) were female. We retrospectively analyzed the clinical outcome with a focus on the preoperative parameters to evaluate the operative risk. Mean follow-up was 4.97 ± 4.1 years.

Result: Preoperative NYHA was in average 2.9, left ventricular ejection fraction 52.5 ± 10.9%, systolic pulmonal artery pressure 38.3 ± 13.0 mm Hg, creatinine 115.4 ± 66.6 μmol/L, bilirubin 20.0 ± 19.6 μmol/L, INR 1.5 ± 0.9, mean MELD-XI Score (Model of End-stage-Liver Disease excluding INR) was 13.3 ± 4.0 μmol/L. Thirty-day mortality was 5.1%, 5-year survival was 59.4 ± 5.4%. Cox regression analysis evaluated the MELD-XI-Score as a highly significant predictor for postoperative mortality (odds ratio: 1.1, CI 95% 1.1–1.2; p < 0.001), while left ventricular function, systolic pulmonary artery pressure, gender and age weren`t.

Conclusion: Hepatorenal dysfunction was the main factor for limited postoperative survival in our patient cohort. The MELD XI score seems to be a reliable score, which is easy to determine and which can predict the perioperative risk in patients with prior cardiac surgery and indication for TV surgery.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021