Timing of Referral of Patients With Severe Isolated Tricuspid Valve Regurgitation to Surgeons (from a French Nationwide Database)

https://doi.org/10.1016/j.amjcard.2018.04.003Get rights and content

Series evaluating the results of isolated tricuspid valve surgery (ITVS) are rare and often limited by small sample size, selection bias, and/or long period of enrollment. Based on a mandatory administrative national database, we collected all consecutive ITVS performed in France during a 2-year period (2013 and 2014), the type of intervention, clinical profile, and in-hospital mortality and complications. During the 2-year period, 241 patients underwent an ITVS in France (84 repairs and 157 replacements). In-hospital mortality was high (10%), and most patients experienced at least 1 complication (65%) with a 19% rate of major complications (death, need for dialysis, or need for mechanical support using extracorporeal membrane oxygenation). Consequently, hospital duration was remarkably long (26 ± 40 days). Congestive heart failure at presentation was associated with mortality and major complications rates (both p = 0.01). In conclusion, in a contemporary and consecutive series, ITVS was associated with a high mortality and morbidity predicted by clinical presentation at baseline. Our results suggest that patients are often referred too late and that an earlier intervention may improve immediate and possibly midterm outcomes. With the availability of transcatheter therapies in a near future, optimal timing of intervention in this population will be of utmost importance.

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Methods

Since the 1991 law on health-care reform, all health-care institutions are mandated to analyze their own activity and transfer the information to the State and to the national health insurance. To achieve this, the PMSI database was created to collect data on patients' diagnoses, procedures, and in-hospital outcome. Each hospitalization is encoded in a standardized dataset which includes patient's information, length of stay, pathologies, and procedures. Diagnoses are coded using the 10th

Results

A total of 241 consecutive patients underwent an ITVS in France during the 2-year study period. Clinical characteristics of this population are presented in Table 1. Mean age was 61 ± 16 years and 128 patients (53%) were women. Eighty-seven patients (36%) had atrial fibrillation, 63 patients (26%) presented with congestive heart failure, and 51 (21%) had a previous left-sided heart valve surgery. TV surgery was performed because of infective endocarditis in 48 patients (20%). Most of the

Discussion

In this large contemporary and consecutive series, ITVS was (1) associated with a high (10%) mortality, (2) responsible for high morbidity with a 19% major complication rate and consequently a remarkably long in-hospital length of stay, and (3) preoperative clinical presentation was an important predictor of in-hospital death and major complication rates. Our results suggest that these patients are often referred too late and that an earlier intervention may improve immediate and possibly

Acknowledgment

We would like to specially thank all the team of HoxCom Analytiques for their help and support on this project.

Disclosures

None of the authors has conflict of interest or disclosure related to the present study.

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