Materials and Methods
A retrospective, single-centre study including patients affected by
tricuspid regurgitation and treated with isolated tricuspid valve
surgery from March 1997 to January 2020 at San Raffaele University
Hospital, Milan, Italy, was conducted. All consecutive patients were
individually reviewed and preoperative, intraoperative and postoperative
data was collected in a dedicated database. The Ethical Committee of our
Institution approved the Study and waived individual informed consent
for this retrospective analysis. Patients were divided into regular
(REG) and non-regular (NEG) postoperative course. Patients were
arbitrarily defined as regular when length-of-stay (LOS) in intensive
care unit (ICU) was less than 4 days and/or postoperative overall LOS
was less than 10 days, without major complications. All patients had
undergone transthoracic (TTE) and transesophageal echocardiography (TEE)
before surgery and transthoracic echocardiogram before discharge.
Transesophageal echocardiography was routinely used to better define the
mechanism of TR. TR grade was graded on a four-grade scale as 1+ (mild),
2+ (moderate), 3+ (moderate-to-severe), and 4+ (severe). In the most
recent years a multiparametric approach according to the current
European Association of Echocardiography recommendations was adopted to
confirm TR grading15–17.
Surgery was performed using standard techniques including bicaval
cannulation or peripheral venous cannulation based on surgeon’s
preference. TV surgery was performed either on beating-heart (BH) or
arrested-heart (AH), using standard median sternotomy approach or right
anterior thoracotomy18,19. Whenever feasible,
tricuspid valve repair was performed. However, valve replacement was
preferred in presence of major geometric deformations of the tricuspid
valve with significant leaflet tethering.
The primary endpoint of the study was the definition of the profile of
patients who had a complicated versus non-complicated postoperative
course. Secondary endpoints were assessment of in-hospital mortality,
number of postoperative complications and identification of predictors
of a favourable or unfavourable hospital outcome.