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CLINICAL STUDIES

Tricuspid valve surgery and intraoperative echocardiography

Factors affecting survival, clinical outcome, and echocardiographic success

Christopher T. Bajzer, MD^*, William J. Stewart, MD, FACC^*, Delos M. Cosgrove, MD, Sami J. Azzam, MD, Kristopher L. Arheart, EdD and Allan L. Klein, MD, FACC^*

^* Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Cardiothoracic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Cardiology, MetroHealth Medical Center, Cleveland, Ohio, USA

Manuscript received January 30, 1998; revised manuscript received May 19, 1998, accepted June 2, 1998.

Address for correspondence: Allan L. Klein, MD, Desk F-15, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44106-0001
kleina{at}ccfmtp.ccf.org

Background. The impact of echocardiographic-guided treatment on outcome after tricuspid valve (TV) surgery is not well defined.

Objectives. The purpose of this study was to determine clinical and echocardiographic factors associated with adverse outcomes after TV surgery and determine the role of intraoperative echo (IOE) in facilitating successful outcomes after TV surgery.

Methods. Four hundred and one patients (279 females, mean age 60 years) underwent TV surgery and other concomitant cardiac surgery at a single institution and were followed clinically and by echocardiography during a 10-year period.

Results. Decreased survival after TV surgery was associated with: preoperative increased New York Heart Association (NYHA) functional classification (relative risk [RR] = 2.02), increased left ventricular dysfunction by echocardiography (RR = 1.28), and use of a TV replacement strategy (RR = 2.92). Decreased event-free survival after TV surgery was associated with concomitant coronary artery bypass grafting (RR = 2.97). Late echocardiographic failure (3 to 4+ tricuspid valve regurgitation [TR]) after TV surgery was associated with increased severity of TR on preoperative echocardiogram (odds ratio [OR] = 1.91). Decreased late echocardiographic failure after TV surgery was associated with the use of a TV annuloplasty ring with a repair strategy (OR = 0.40). The surgical plan was altered at the time of surgery to insure a successful outcome in 32 (10%) of 335 patients based on IOE findings.

Conclusions. Adverse outcomes after TV surgery can be predicted by several preoperative clinical and echocardiographic variables. IOE is useful in improving immediate, but not late, outcomes after TV surgery.

Abbreviations and Acronyms   IOE = intraoperative echocardiogram or intraoperative echocardiography   NYHA = New York Heart Association   OR = odds ratio   RR = relative risk   TR = tricuspid valve regurgitation   TV = tricuspid valve

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