TRICUSPID-VALVE SURGERY AND INTRAOPERATIVE ECHOCARDIOGRAPHY - FACTORSAFFECTING SURVIVAL, CLINICAL OUTCOME, AND ECHOCARDIOGRAPHIC SUCCESS

Background. The impact of echocardiographic-guided treat ment on outco me after tricuspid valve (TV) surgery is not well defined. Objectives. The purpose of this study was to determine clinical and echocardiogra phic factors associated with adverse outcomes after TV surgery and det ermine the role of intraoperative echo (IOE) in facilitating successfu l outcomes after TV surgery. Methods. Four hundred and one patients (2 79 females, mean age 60 years) underwent TV surgery and other concomit ant cardiac surgery at a single institution and were followed clinical ly and by echocardiography during a 10-year period. Results. Decreased survival after TV surgery was associated with: preoperative increased New York Heart Association (NYHA) functional classification (relative risk [RR] = 2.02), increased left ventricular dysfunction by echocard iography (RR = 1.28), and use of a TV replacement strategy (RR = 2.92) . Decreased event-free survival after TV surgery was associated with c oncomitant coronary artery bypass grafting (RR = 2.97). Late echocardi ographic failure (3 to 4+ tricuspid valve regurgitation [TR]) after TV surgery was associated with increased severity of TR on preoperative echocardiogram (odds ratio [OR] = 1.91). Decreased late echocardiograp hic failure after TV surgery was associated with the use of a TV annul oplasty ring with a repair strategy (OR = 0.40). The surgical plan was altered at the time of surgery to insure a successful outcome in 32 ( 10%) of 335 patients based on IOE findings. Conclusions. Adverse outco mes after TV surgery can be predicted by several preoperative clinical and echocardiographic variables. IOE is useful in improving immediate , but not late, outcomes after TV surgery. (C) 1998 by the American Co llege of Cardiology.