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Complicated postoperative course in isolated tricuspid valve surgery: looking for predictors
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  • Alessandra Sala,
  • Roberto Lorusso,
  • Marta Bargagna,
  • Stefania Ruggeri,
  • Nicola Buzzatti,
  • Anna Mara Scandroglio,
  • Fabrizio Monaco,
  • Eustachio Agricola,
  • Andrea Giacomini,
  • Davide Carino,
  • Roberta Meneghin,
  • Davide Schiavi,
  • Elisabetta Lapenna,
  • Paolo Denti,
  • Andrea Blasio,
  • Ottavio Alfieri,
  • Alessandro Castiglioni,
  • Michele De Bonis
Alessandra Sala
Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy
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Roberto Lorusso
Maastricht University Medical Centre
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Marta Bargagna
IRCCS Ospedale San Raffaele
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Stefania Ruggeri
San Raffaele Hospital
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Nicola Buzzatti
San Raffaele University Hospital
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Anna Mara Scandroglio
San Raffaele Hospital
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Fabrizio Monaco
Ospedale San Raffaele
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Eustachio Agricola
IRCCS Ospedale San Raffaele
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Andrea Giacomini
IRCCS Ospedale San Raffaele
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Davide Carino
IRCCS Ospedale San Raffaele
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Roberta Meneghin
IRCCS Ospedale San Raffaele
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Davide Schiavi
Ospedale San Raffaele
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Elisabetta Lapenna
San Raffaele University Hospital
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Paolo Denti
San Raffaele Hospital
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Andrea Blasio
San Raffaele University Hospital
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Ottavio Alfieri
S.Raffaele Hospital
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Alessandro Castiglioni
UniversitĂ  Vita Salute San Raffaele
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Michele De Bonis
Ospedale San Raffaele
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Abstract

Background: This study aims at better defining the profile of patients with a complicated versus non-complicated postoperative course following isolated tricuspid valve (TV) surgery to identify predictors of a favourable/unfavourable hospital outcome. Methods: All patients treated with isolated tricuspid surgery from March 1997-January 2020 at our institution were retrospectively reviewed. Considering the complexity of most of these patients, a regular postoperative course was arbitrarily defined as a length-of-stay in intensive care unit <4 days and/or postoperative length-of-stay <10days. Patients were therefore divided accordingly in two groups. Results: 172 patients were considered, among whom 97 (56.3%) had a regular (REG) and 75 (43.6%) a non-regular (NEG) postoperative course. The latter had worse baseline clinical and echocardiographic characteristics, with higher rate of renal insufficiency, previous heart failure hospitalizations, cardiac operations, and right ventricular dysfunction. NEG patients more frequently needed tricuspid replacement and experienced a greater number of complications (p<0.001) and higher in-hospital mortality (13% vs 0%, p<0.001). The majority of these complications were related to more advanced stage of the tricuspid disease. Among most important predictors of a negative outcome univariate analysis identified chronic kidney disease, ascites, previous right heart failure hospitalizations, right ventricular dysfunction, previous cardiac surgeries, TV replacement and higher MELD scores. At multivariate analysis, liver enzymes and diuretics’ dose were predictors of complicated postoperative course. Conclusions: In isolated TV surgery a complicated postoperative course is observed in patients with more advanced right heart failure and organ damage. Earlier surgical referral is associated to excellent outcomes and should be recommended.

Peer review status:ACCEPTED

13 May 2021Submitted to Journal of Cardiac Surgery
14 May 2021Assigned to Editor
14 May 2021Submission Checks Completed
17 May 2021Reviewer(s) Assigned
01 Jun 2021Review(s) Completed, Editorial Evaluation Pending
03 Jun 2021Editorial Decision: Accept