Key result
Mitral replacement plus tricuspid repair in triple valve surgery is linked to ~90% lower mortality.
Why the study?
Triple valve surgery remains a surgical challenge associated with notable mortality and morbidity, prompting an evaluation of early and mid-term outcomes across a multicenter registry.
What are the early and mid-term mortality outcomes and risk factors in patients undergoing triple valve surgery?
Cohort (n=280)
Yes
What are the early and mid-term mortality outcomes and risk factors in patients undergoing triple valve surgery?
Triple valve surgery achieves satisfactory in-hospital (7.9%) and 5-year (28.9%) mortality rates, with mitral valve replacement plus tricuspid repair showing superior survival over mitral repair in this setting, while renal failure, reoperation, and concomitant CABG significantly increase surgical risk.
Answers are grounded in this paper and cite their sources.
Informs valve strategy selection in triple valve surgery; leaves open randomized confirmation of survival differences.
AIMS: Triple valve surgery (TVS) may still be considered a challenge in cardiac surgery, and is still associated with a not negligible mortality and morbidity. This study analyzed retrospectively patients' data from RERIC (Registro Regionale degli Interventi Cardiochirurgici) registry, to evaluate early and mid-term results of TVS. METHODS: From April 2002 to December 2013, data from n = 44 211 cardiac surgical procedures were collected from six Cardiac Surgery Departments (RERIC). Two hundred and eighty patients undergoing TVS were identified, including aortic and mitral replacement with tricuspid repair in 211 patients (75.3%), aortic replacement with mitral and tricuspid repair in 64 (22.9%) and triple valve replacement in 5 (1.8%). Univariate and multivariate analyses were performed to identify predictors of overall mortality or adverse outcomes. RESULTS: The mean age of the patients was 67.5 ± 12.2. Overall in-hospital mortality rate was 7.9%: in-hospital mortality was 10.9% in mitral valve repair and 6.6% in mitral valve replacement, respectively. Tricuspid valve replacement was associated with the highest mortality rate (40%). Independent predictors of in-hospital mortality were serum creatinine greater than 2 mg/dl [odds ratio (OR) 4.5; P = 0.03], concomitant coronary artery bypass graft (CABG) (OR 3.8; P = 0.01) and previous cardiac surgery (OR 5.1; P = 0.04). Overall cumulative mortality rate at 1, 3 and 5 years was 14.7, 24.1 and 28.9%, respectively. Mitral valve replacement associated with tricuspid valve repair showed better survival rate (hazard ratio 0.1; P = 0.007). CONCLUSION: TVS has demonstrated satisfactory results in terms of in-hospital and mid-term mortality rate. Renal failure, reoperations and concomitant CABG resulted as risk factors for mortality; moreover, we could not demonstrate a mid-term better survival rate of mitral valve repair compared with the replacement.
No takes yet. Share an insight, caveat, or question.
Fortuna et al. (2018) conducted a cohort in Triple valve disease requiring triple valve surgery (n=280). Triple valve surgery (aortic and mitral replacement with tricuspid repair, aortic replacement with mitral and tricuspid repair, or triple valve replacement) vs. Comparison across surgical subtypes (e.g., mitral valve repair vs mitral valve replacement) was evaluated on In-hospital and overall cumulative mortality (HR 0.1, p=0.007). Triple valve surgery had a 7.9% in-hospital and 28.9% 5-year mortality rate, with mitral replacement plus tricuspid repair showing superior survival (HR 0.1, P=0.007).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: