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Long Term Outcomes Of Minimally Invasive Redo Tricuspid Valve Surgery
Giacomo Bianchi, MD, PhD, Margaryan Rafik, MD, PhD, Marco Solinas, MD.
Fondazione Toscana Monasterio - Ospedale del Cuore, Massa, Italy.
Background: Reoperative tricuspid valve surgery carries significant perioperative risk, necessitating careful patient selection based on risk factors for both short and long-term outcomes.
Methods: This retrospective study examined consecutive patients who underwent isolated tricuspid valve reintervention following previous CABG or left-sided valve surgery. The study evaluated the MELD score's utility in predicting outcomes and identified risk factors for mortality.
Results: The study included 115 patients with a median age of 67 years. In-hospital mortality was 7.8%. The MELD score demonstrated moderate discriminatory power (AUC 0.68) for predicting in-hospital mortality. Survival rates were 92.6% at 1 year, 71.1% at 5 years, and 43.9% at 10 years. Major complications included acute kidney injury (28%), bleeding requiring reoperation (16%), stroke (7.8%), and permanent pacemaker implantation (11%). Multivariate analysis identified age, preoperative left ventricular ejection fraction, postoperative acute kidney injury, and major adverse cardiovascular and cerebrovascular events (MACCE) as significant predictors of long-term mortality.
Conclusions: While reoperative tricuspid valve surgery remains challenging, it can be performed with acceptable in-hospital mortality at specialized heart valve centers. The MELD score proves useful in risk stratification for both in-hospital mortality and long-term outcomes. Patient outcomes are significantly influenced by age, functional status, left ventricular function, and postoperative complications, particularly acute kidney injury and MACCE.
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