The Fate of Concomitant Tricuspid Regurgitation in Patients Undergoing Coronary Artery Bypass Grafting

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Abstract Submission 

Daisuke Kaneyuki (1), Carlos A Gallego-Navarro (2), Austin Todd (3), Hector Villarraga (4), Juan Crestanello (2), Kevin Greason (2), Hartzell Schaff, MD (2), Arman Arghami (2)

(1) 1- Department of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, (2) 2- Department of Cardiovascular Surgery, Mayo Clinic Rochester, Rochester, MN, (3) 3- Department of Biostatistics, Mayo Clinic Rochester, Rochester, MN, (4) 4- Department of Cardiovascular Disease, Mayo Clinic Rochester, Rochester, MN

Daisuke Kaneyuki    -  Contact Me
1- Department of Cardiac Surgery, Thomas Jefferson University Hospital

Carlos A Gallego-Navarro    -  Contact Me
2- Department of Cardiovascular Surgery, Mayo Clinic Rochester

Austin Todd    -  Contact Me
3- Department of Biostatistics, Mayo Clinic Rochester

Hector Villarraga    -  Contact Me
4- Department of Cardiovascular Disease, Mayo Clinic Rochester

*Juan Crestanello    -  Contact Me
2- Department of Cardiovascular Surgery, Mayo Clinic Rochester

*Kevin Greason    -  Contact Me
2- Department of Cardiovascular Surgery, Mayo Clinic Rochester

*Hartzell Schaff, MD    -  Contact Me
2- Department of Cardiovascular Surgery, Mayo Clinic Rochester

Arman Arghami    -  Contact Me
2- Department of Cardiovascular Surgery, Mayo Clinic Rochester

Daisuke Kaneyuki    -  Contact Me
N/A

Objective: Due to lack of supportive data, tricuspid regurgitation (TR) is usually not addressed for patient undergoing coronary artery bypass grafting (CABG). Here we evaluate changes in degree of TR over time and its impact on survival in patient undergoing CABG.
Methods: We reviewed data of 10183 patients who underwent isolated CABG between January 2000 and January 2021. Patients were stratified by severity of preoperative TR and divided into two groups: non-significant TR (none-trivial, mild) and significant TR (moderate, severe). We excluded patients who had undergone previous tricuspid valve surgery and underwent concomitant valve or ablative surgery. Propensity score matching and Cox proportional hazards models were used to determine association between grade of TR and the primary endpoint of all-cause mortality. The secondary endpoint was the change of TR severity on postoperative echocardiography.
Results: After propensity score matching, 826 patients were identified (413 in each group). At baseline, 290 (70.2%) and 123 (29.8%) patients had none-trivial and mild TR in non-significant TR group, respectively. Similarly, 388 (93.9%) and 25 (6.1%) patients had moderate and severe TR in significant TR group, respectively. On postoperative echo TR improved in 6.3% of patient in the non-significant group and 25.7% in the significant group (Figure 1). The Kaplan-Meier survival curve demonstrated a significant survival difference between patient with preoperative non-significant and significant TR (p < 0.001). But after adjusting for significant confounders (age, sex, preoperative diabetes mellitus, preoperative atrial fibrillation, left ventricular function and pulmonary artery systolic pressure), the significant TR group did not show any worse survival as compared to the non-significant group (HR 1.13; 95% CI, 0.88-1.5; p = 0.38). While age (HR 1.05; 95% CI, 1.03-1.1; p < 0.001), preoperative diabetes mellitus (HR 1.74; 95% CI, 1.38-2.2; p < 0.001), and pulmonary artery systolic pressure (HR 1.01; 95% CI, 1.00-1.02; p = 0.009) were significantly associated with increased risk of mortality.
Conclusions: Significant (moderate or severe) preoperative TR improves in 25.7% patient after isolated CABG, while non-significant (trace or mild) TR can worsen in 39.7%. But more importantly after adjusting for other factors significant TR does not seem to affect long-term survival after isolated CABG.

Mitral and Tricuspid Valve