Key result
Hepatic dysfunction in tricuspid valve surgery is linked to lower long-term survival despite similar early mortality.
Why the study?
Hepatic dysfunction frequently accompanies chronic tricuspid regurgitation and increases surgical risk, but its clinical impact in patients with severe tricuspid regurgitation is not well documented.
Does hepatic dysfunction worsen long-term survival in patients undergoing surgery for moderate to severe tricuspid regurgitation?
Cohort (n=101)
Does hepatic dysfunction worsen long-term survival in patients undergoing surgery for moderate to severe tricuspid regurgitation?
Absolute Event Rate: 2.2% vs 0%
p-value: p=0.446
While early surgical outcomes for tricuspid regurgitation are acceptable in patients with hepatic dysfunction, their compromised long-term survival highlights the need for earlier surgical intervention before irreversible liver damage occurs.
TR surgery yields acceptable early outcomes despite HD; leaves open optimal timing assessment via MELD in prospective cohorts.
Background: Hepatic dysfunction (HD) is frequently associated with chronic tricuspid regurgitation (TR), and is a risk factor for TR surgery. Late referral of patients with TR is associated with the progression of TR and HD, as well as an increase in surgical morbidity and mortality. Many patients with severe TR suffer from HD; however, their clinical impact is not well documented. Methods: This retrospective review was conducted between October 2008 and July 2017. In total, 159 consecutive patients underwent surgery for TR; 101 with moderate to severe TR were included. We divided patients into N (normal liver function; n=56) and HD (HD; n=45) groups. HD was defined as clinically or radiologically diagnosed liver cirrhosis, or a preoperative Model for End-Stage Liver Disease (MELD)-XI score ≥13. Perioperative data were compared between groups, and changes in the MELD score following TR surgery were estimated in the HD group. Long-term survival rates were analyzed, and analyses were performed to obtain the assessment tool and cutoff value to determine the degree of HD affecting late mortality. Results: The preoperative demographics of both groups were similar, excluding the presence of HD. The EuroSCORE II, MELD score, and prothrombin time international normalization ratio were significantly higher in the HD group, and although early mortality was comparable between groups [N group: 0%, HD group: 2.2% (n=1); P=0.446], intensive care unit and hospital stays were significantly longer in the HD group. The MELD score in the HD group temporarily increased immediately after surgery, and then decreased. The long-term survival rates were significantly lower in the HD group. The most suitable tool for predicting late mortality was the MELD-XI score, with a cutoff value of 13 points. Conclusions: Surgery for patients with severe TR can be performed with relatively low morbidity and operative mortality, regardless of associated HD. MELD scores significantly improved after TR surgery in patients with HD. Even with favorable early outcomes, compromised long-term survival with HD suggests the need to develop an assessment tool that can evaluate the appropriate timing for TR surgery.
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Lim et al. (2023) conducted a cohort in Moderate to severe tricuspid regurgitation (n=101). Hepatic dysfunction vs. Normal liver function was evaluated on Early mortality (p=0.446). Hepatic dysfunction in patients undergoing tricuspid valve surgery was associated with similar early mortality compared to normal liver function (2.2% vs 0%; P=0.446), but lower long-term survival.
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