Cirugía de la regurgitación tricuspídea grave: resultados a corto y largo plazo / Short- and long-term outcomes of surgery for severe tricuspid regurgitation

Introducción y objetivos. En nuestro medio hay pocos datos sobre los resultados del tratamiento quirúrgico de la insuficiencia tricuspídea grave. Nuestro objetivo es analizar los resultados clínicos y ecocardiográficos de nuestra población con insuficiencia tricuspídea grave sometida a cirugía comparándolos según el tipo de reparación o de sustitución valvular. Métodos. Realizamos un estudio retrospectivo incluyendo a 119 pacientes consecutivos con insuficiencia tricuspídea grave sometidos a cirugía de dicha válvula entre abril de 1996 y febrero de 2010. Resultados. Se realizaron 61 anuloplastias sin anillo y 23 con anillo, y se implantaron 11 prótesis biológicas y 24 mecánicas. La mortalidad perioperatoria fue del 18,5%, y se asociaron a ella la edad y el tiempo de circulación extracorpórea. Durante el seguimiento clínico (mediana, 41 [intervalo intercuartílico, 24-89] meses), el grupo anuloplastia con anillo precisó dos reoperaciones, al igual que el grupo de prótesis mecánica, en el que se diagnosticó trombosis protésica a 4 pacientes. La mortalidad total tras seguimiento fue del 29,9%, y se asociaron a ella la edad > 70 años y el tiempo de circulación extracorpórea. La aparición de nueva insuficiencia tricuspídea grave se asoció a la edad y la anuloplastia sin anillo (p = 0,04). Conclusiones. La reparación sin anillo se asoció significativamente con recurrencia de insuficiencia tricuspídea grave. El implante de prótesis mecánica se asoció a una elevada tasa de trombosis en el seguimiento. No se encontraron diferencias significativas en la mortalidad perioperatoria o total según el tipo de reparación o sustitución valvular (AU)

Introduction and objectives: There is little data available for Spain on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. Methods: Retrospective study in 119 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 1996 and February 2010. Results: A total of 61 ringless and 23 ring annuloplasties were performed and 11 bioprostheses and 24 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24-89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age>70 years and extracorporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty (P=.04). Conclusions: Ringless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement (AU)

Short- and long-term outcomes of surgery for severe tricuspid regurgitation.

INTRODUCTION AND OBJECTIVES: There is little data available for Spain on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement. METHODS: Retrospective study in 119 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 1996 and February 2010. RESULTS: A total of 61 ringless and 23 ring annuloplasties were performed and 11 bioprostheses and 24 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24-89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age>70 years and extracorporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty (P=.04). CONCLUSIONS: Ringless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement.