39. The Fate of Concomitant Tricuspid Regurgitation in Patients Undergoing Coronary Artery Bypass Grafting
CHUV
Lausanne, -
Switzerland - Contact Me
Patrick Myers is a consultant cardiac surgeon at CHUV - Lausanne University Hospitals in Switzerland and Privat Docent at the Geneva University Medical School. After finishing medical school in Geneva, Patrick completed his cardiovascular surgery residency at the Geneva University Hospitals. He served as senior fellow in adult cardiac surgery at Brigham & Women’s Hospital and Harvard Medical School and then as fellow in cardiac surgery at Boston Children’s Hospital. He was appointed instructor in surgery at Boston Children’s Hospital & Harvard Medical School, before returning as attending surgeon in adult and congenital cardiac surgery in Geneva, Switzerland, where he was named associate of the chief of cardiac surgery. Since 2017, he has focused on adult cardiac surgery in his private practice in adult cardiac surgery in Geneva and serves as consultant cardiac surgeon at CHUV Lausanne. He has served as secretary of the European Board for Cardio-Thoracic Surgery, chair of the EACTS Acquired Cardiac Diseases Domain, Secretary General of EACTS since 2022, and president of CTSNet. His areas of interest are multiple arterial coronary artery bypass grafting, evolving transcatheter techniques to treat structural heart disease, HOCM and critical appraisal of clinical trials and their discussions on social media.
NewYork- Presbyterian/Columbia University Medical Center
New York, NY
United States - Contact Me
Daisuke Kaneyuki is a clinical instructor, Division of Cardiac Surgery, Department of Surgery at Columbia University, NY, USA. He had completed his cardiac surgery residency training in Japan in 2020. Then he successfully completed Advanced Adult Cardiac Surgical Fellowship at Mayo Clinic, MN, USA between 2020-2021 and Cardiac Surgical Fellowship at Thomas Jefferson University Hospital between 2021-2023. He continues Advanced Adult Cardiac Surgery/LVAD/Tranplant Fellowship at Columbia University. He is interested in general adult cardiac surgery including robotic, minimally invasive surgery, MCS and transplantation.
Abstract
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.