Complicated postoperative course in isolated tricuspid valve surgery:
looking for predictors
Abstract
Background: This study aims at better defining the profile of patients
with a complicated versus non-complicated postoperative course following
isolated tricuspid valve (TV) surgery to identify predictors of a
favourable/unfavourable hospital outcome. Methods: All patients treated
with isolated tricuspid surgery from March 1997-January 2020 at our
institution were retrospectively reviewed. Considering the complexity of
most of these patients, a regular postoperative course was arbitrarily
defined as a length-of-stay in intensive care unit <4 days
and/or postoperative length-of-stay <10days. Patients were
therefore divided accordingly in two groups. Results: 172 patients were
considered, among whom 97 (56.3%) had a regular (REG) and 75 (43.6%) a
non-regular (NEG) postoperative course. The latter had worse baseline
clinical and echocardiographic characteristics, with higher rate of
renal insufficiency, previous heart failure hospitalizations, cardiac
operations, and right ventricular dysfunction. NEG patients more
frequently needed tricuspid replacement and experienced a greater number
of complications (p<0.001) and higher in-hospital mortality
(13% vs 0%, p<0.001). The majority of these complications
were related to more advanced stage of the tricuspid disease. Among most
important predictors of a negative outcome univariate analysis
identified chronic kidney disease, ascites, previous right heart failure
hospitalizations, right ventricular dysfunction, previous cardiac
surgeries, TV replacement and higher MELD scores. At multivariate
analysis, liver enzymes and diuretics’ dose were predictors of
complicated postoperative course. Conclusions: In isolated TV surgery a
complicated postoperative course is observed in patients with more
advanced right heart failure and organ damage. Earlier surgical referral
is associated to excellent outcomes and should be recommended.