Association Between Functional Tricuspid Regurgitation and Mortality Following Cardiac Surgery

Timothy C Tan; Louis Mullie; Aidan W Flynn; Praveen Mehrotra; David M Shahian; Maria Carmo P Nunes; Michael H Picard; Jonathan Afilalo

doi:10.1016/j.jacadv.2023.100551

Association Between Functional Tricuspid Regurgitation and Mortality Following Cardiac Surgery

JACC Adv. 2023 Sep 1;2(7):100551. doi: 10.1016/j.jacadv.2023.100551. eCollection 2023 Sep.

Authors

Timothy C Tan¹, Louis Mullie², Aidan W Flynn¹, Praveen Mehrotra¹, David M Shahian^{3

4}, Maria Carmo P Nunes¹, Michael H Picard¹, Jonathan Afilalo^{1

2

5}

Affiliations

¹ Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA.
² Centre for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
³ Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA.
⁴ Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA.
⁵ Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.

Abstract

Background: Current guidelines recommend concomitant repair of certain non-severe cases of tricuspid regurgitation (TR) in patients undergoing cardiac surgery, but the prognostic relevance and postsurgical impact of the TR remain uncertain.

Objectives: The purpose of this study was to determine the prognostic impact of functional TR in patients undergoing diverse cardiac surgeries and to examine the effect-modifying role of patient characteristics in patients in whom TR confers a greater risk of adverse outcomes.

Methods: Patients undergoing coronary artery bypass, aortic, and mitral valve surgery were included. Patients with severe TR, organic tricuspid valve pathology, undergoing tricuspid valve surgery or without a recent preoperative echocardiogram were excluded. Clinical variables were extracted from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. An independent cohort was used for external validation.

Results: Of 2,119 patients (mean age 67.4 years; 29% females), TR severity was moderate in 185 (9%), mild in 636 (30%), trivial in 1,126 (53%), and absent in 172 (8%). There were 238 deaths during the median follow-up period of 2.6 years. After adjusting for relevant factors, moderate TR was found to be independently associated with mid-term mortality (HR: 2.58; 95% CI: 1.22-5.47) and with in-hospital mortality or major morbidity (OR: 3.18; 95% CI: 1.37-7.42). The association between TR and mortality was apparent when preoperative pulmonary artery systolic pressure was <40 mm Hg but not ≥40 mm Hg (P for interaction = 0.036).

Conclusions: In this diverse cohort of contemporary cardiac surgery patients, moderate functional TR was associated with increased mortality and major morbidity, particularly in the absence of pulmonary hypertension.

Keywords: cardiac surgery; echocardiography; mortality; tricuspid regurgitation.