MP68. The effect of Diastolic Arrest on Outcomes in Tricuspid Valve Surgery
Presented During: Moderated E-Posters
Troy, VA
United States - Contact Me
Steven Young, MD is a second-year thoracic surgery resident at the University of Virginia, he is interested in adult cardiac surgery and outcomes in heart failure surgery.
Contact: [email protected]
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objectives:
Tricuspid valve surgery is an area of growing interest. Whether operative outcomes differ with the heart arrested or beating during the procedure remains unanswered. We hypothesize that the performance of tricuspid surgery with the heart beating is associated with shorter bypass time, operating room (OR) time and lower mortality.
Methods:
Patients undergoing tricuspid valve surgery at a single center between 2016 and 2021 were included. Patients were stratified by whether the tricuspid portion of the operation was performed with the heart in diastolic arrest. Chi-squared and Wilcoxon Two-Sample tests were performed on continuous and categorical variables, respectively, to determine the effect arrest had on complication rates.
Results:
A total of 255 patients underwent a tricuspid valve surgery during this period, 100 were isolated tricuspid procedures, 155 were performed concomitantly. A total of 199 (78.0%) patients had the heart arrested during the tricuspid portion of the operation. Beating heart tricuspid procedures were not significantly associated with urgency, age, gender, previous valve surgery or STS predicted risk of morbidity or mortality. A higher percentage of beating heart procedures were on patients with ESRD (p=0.003) and beating heart procedure patients had higher MELD scores (p=0.01). Amongst all-comers there was no difference in bypass time (p=0.40), total OR time (p=0.33), operative mortality (p=0.62) or reoperation (p=0.97). Arrested heart tricuspid procedures had a shorter length of stay (14.6 vs. 16.8 days, p=0.03). Amongst concomitant tricuspid procedures, diastolic arrest procedures had decreased bypass time (195 vs. 261 minutes, p<0.01) and OR time (445 vs. 551 minutes, p<0.01). In isolated tricuspid procedures diastolic arrest resulted in shorter ICU length of stay (219 vs. 246 hours, p=0.046).
Conclusions:
Among all-comers, performing tricuspid valve surgery on an arrested heart resulted in a shorter length of stay and no significant differences in bypass time, total OR time, or operative mortality. Patients undergoing isolated beating heart tricuspid procedures had longer ICU length of stay, patients undergoing concomitant beating heart tricuspid surgery had longer bypass time and OR time. These results indicate that the decision to perform tricuspid valve surgery on a beating heart may lengthen operative time and length of stay, however prospective studies are needed to further examine these effects.
Tricuspid valve surgery is an area of growing interest. Whether operative outcomes differ with the heart arrested or beating during the procedure remains unanswered. We hypothesize that the performance of tricuspid surgery with the heart beating is associated with shorter bypass time, operating room (OR) time and lower mortality.
Methods:
Patients undergoing tricuspid valve surgery at a single center between 2016 and 2021 were included. Patients were stratified by whether the tricuspid portion of the operation was performed with the heart in diastolic arrest. Chi-squared and Wilcoxon Two-Sample tests were performed on continuous and categorical variables, respectively, to determine the effect arrest had on complication rates.
Results:
A total of 255 patients underwent a tricuspid valve surgery during this period, 100 were isolated tricuspid procedures, 155 were performed concomitantly. A total of 199 (78.0%) patients had the heart arrested during the tricuspid portion of the operation. Beating heart tricuspid procedures were not significantly associated with urgency, age, gender, previous valve surgery or STS predicted risk of morbidity or mortality. A higher percentage of beating heart procedures were on patients with ESRD (p=0.003) and beating heart procedure patients had higher MELD scores (p=0.01). Amongst all-comers there was no difference in bypass time (p=0.40), total OR time (p=0.33), operative mortality (p=0.62) or reoperation (p=0.97). Arrested heart tricuspid procedures had a shorter length of stay (14.6 vs. 16.8 days, p=0.03). Amongst concomitant tricuspid procedures, diastolic arrest procedures had decreased bypass time (195 vs. 261 minutes, p<0.01) and OR time (445 vs. 551 minutes, p<0.01). In isolated tricuspid procedures diastolic arrest resulted in shorter ICU length of stay (219 vs. 246 hours, p=0.046).
Conclusions:
Among all-comers, performing tricuspid valve surgery on an arrested heart resulted in a shorter length of stay and no significant differences in bypass time, total OR time, or operative mortality. Patients undergoing isolated beating heart tricuspid procedures had longer ICU length of stay, patients undergoing concomitant beating heart tricuspid surgery had longer bypass time and OR time. These results indicate that the decision to perform tricuspid valve surgery on a beating heart may lengthen operative time and length of stay, however prospective studies are needed to further examine these effects.