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DOI: 10.1055/s-0034-1367110
Tricuspid valve surgery - should we prefer the beating heart technique?
Objectives: Tricuspid valve (TV) surgery is associated with high risks in terms of morbidity and mortality. We aimed to evaluate the long-term outcome after isolated TV surgery and thereby focused on potential advantages of the beating heart technique.
Methods: The long-term results of 92 consecutive patients who underwent isolated TV surgery at a single institution were evaluated and the risk factors for TV re-operation and mortality were analysed. We compared patients who underwent beating heart (BH) surgery (n = 48) with patients undergoing arrested heart (AH) surgery (n = 44). Follow up analyses included telephone interviews and echocardiographic examinations.
Results: BH surgery was more frequently chosen in urgent/emergent operations (p = 0.029) and in redo-operations (p < 0.001). Pre-operatively, the rates of renal insufficiency (p = 0.002) and the EuroSCORE (p = 0.019) were higher in the BH group than in the AH group. There was no difference in perioperative outcome and 30-day mortality between the groups. However, freedom from re-operation was significantly lower in the BH group compared to the AH group (p = 0.039). We observed a trend to lower survival rates at 1, 5 and 10 years in the BH group (77%, 54%, and 41%) compared to the AH group (86%, 75%, and 72%, p = 0.062). A multivariate Cox hazard model revealed atrial fibrillation/pacemaker dependency (p = 0.014, odds ratio [OR] = 2.296) and EuroSCORE (p = 0.022, [OR] = 1.049) as independent risk factors for mortality after isolated TV surgery.
Conclusion: Isolated tricuspid valve surgery should be considered early, since patients with elevated EuroSCORES, atrial fibrillation and/or pacemaker dependency have significantly higher mortality rates. We did not observe any long-term benefits of the beating heart technique.