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Delay of surgical treatment of severe tricuspid regurgitation and outcomes in patients with left-sided heart valve disease
Demora en el tratamiento quirúrgico de la insuficiencia tricuspídea grave y resultados en pacientes con valvulopatía izquierda
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Yolanda Carrascala,b,
Corresponding author
ycarrascal@hotmail.com

Corresponding author:
, Bárbara Seguraa, Cristina Sáncheza, Eduardo Velascoa
a Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
b Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Universidad de Valladolid, Valladolid, Spain
Article information
ABSTRACT

Introduction and objectives: The influence of the delay between diagnosis and surgery in severe tricuspid regurgitation (TR) remains controversial. We aimed to analyze the association between delay to surgery and operative and mid-term mortality in patients with severe TR concomitant to left-valve surgery.

Methods: We conducted an observational retrospective study analyzing risk factors in patients undergoing left-valve surgery concomitant with severe TR. The clinical and demographic variables were prospectively collected. The time of first diagnosis of TR was retrospectively collected.

Results: A total of 253 patients were analyzed. TR was functional in 82.6%. The median latency between diagnosis and surgery was 24 months. Operative mortality was 12.2%. On multivariate analysis, higher operative mortality was associated with older age, worse preoperative NYHA functional class, triple valve surgery, hyponatremia, and anemia. The median follow-up was 35 months. Survival at 1 and 5 years was 85.2% and 73.7%, respectively. Mortality during follow-up was associated with male sex, preoperative massive TR, and longer latency between diagnosis and surgery.

Conclusions: The variables related to worse preoperative functional class were associated with increased operative mortality. Lower mid-term survival was associated with longer latency between diagnosis of severe TR and surgery, massive preoperative TR, and older age.

Keywords:
Tricuspid valve regurgitation
In-hospital mortality
Cardiac surgery
Abbreviations:
TR
RH
RESUMEN

Introducción y objetivos: La influencia de la demora entre diagnóstico y cirugía de la insuficiencia tricuspídea (IT) grave es controvertida. Analizamos la asociación entre demora quirúrgica y mortalidad, operatoria y a medio plazo, en pacientes con IT grave asociada a cirugía valvular izquierda.

Métodos: Se hizo un estudio observacional retrospectivo de factores de riesgo en pacientes operados por valvulopatía izquierda asociada a IT grave. Las variables clínicas y demográficas se recogieron prospectivamente, y retrospectivamente el momento del primer diagnóstico de IT grave.

Resultados: Se analizó a 253 pacientes. La insuficiencia tricúspide fue funcional en el 82,6 %. La mediana entre diagnóstico y cirugía fue de 24 meses. La mortalidad quirúrgica fue del 12,2 %. En el análisis multivariante la mayor edad, peor clase funcional preoperatoria, triple cirugía valvular, hiponatremia y anemia se asociaron a mayor mortalidad operatoria. La mediana de seguimiento fue de 35 meses. La supervivencia a 1 y 5 años fue del 85,2% y 73,7%, respectivamente. El sexo masculino, la presencia de IT masiva preoperatoria y la demora entre diagnóstico de IT grave y cirugía se asociaron a mayor mortalidad durante el seguimiento.

Conclusiones: Las variables relacionadas con una peor clase funcional se asociaron al incremento de la mortalidad operatoria. La mayor latencia entre el diagnóstico de insuficiencia tricúspide severa y cirugía y el diagnóstico preoperatorio de insuficiencia tricúspide masiva y la edad se asociaron con una disminución de la supervivencia a medio plazo.

Palabras clave:
Insuficiencia tricuspídea
Mortalidad hospitalaria
Cirugía cardiaca
Abreviaturas:
IT
CD

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