Materials and Methods
A retrospective, single-centre study including patients affected by tricuspid regurgitation and treated with isolated tricuspid valve surgery from March 1997 to January 2020 at San Raffaele University Hospital, Milan, Italy, was conducted. All consecutive patients were individually reviewed and preoperative, intraoperative and postoperative data was collected in a dedicated database. The Ethical Committee of our Institution approved the Study and waived individual informed consent for this retrospective analysis. Patients were divided into regular (REG) and non-regular (NEG) postoperative course. Patients were arbitrarily defined as regular when length-of-stay (LOS) in intensive care unit (ICU) was less than 4 days and/or postoperative overall LOS was less than 10 days, without major complications. All patients had undergone transthoracic (TTE) and transesophageal echocardiography (TEE) before surgery and transthoracic echocardiogram before discharge. Transesophageal echocardiography was routinely used to better define the mechanism of TR. TR grade was graded on a four-grade scale as 1+ (mild), 2+ (moderate), 3+ (moderate-to-severe), and 4+ (severe). In the most recent years a multiparametric approach according to the current European Association of Echocardiography recommendations was adopted to confirm TR grading15–17.
Surgery was performed using standard techniques including bicaval cannulation or peripheral venous cannulation based on surgeon’s preference. TV surgery was performed either on beating-heart (BH) or arrested-heart (AH), using standard median sternotomy approach or right anterior thoracotomy18,19. Whenever feasible, tricuspid valve repair was performed. However, valve replacement was preferred in presence of major geometric deformations of the tricuspid valve with significant leaflet tethering.
The primary endpoint of the study was the definition of the profile of patients who had a complicated versus non-complicated postoperative course. Secondary endpoints were assessment of in-hospital mortality, number of postoperative complications and identification of predictors of a favourable or unfavourable hospital outcome.