Introduction
Interest in tricuspid valve (TV) pathology has recently grown, due to reported poor clinical outcome of patients affected by tricuspid regurgitation (TR) and the impact on long-term survival of such pathology1–3. In particular, isolated TR has been traditionally managed with medical therapy for a long time before referring patients to surgery. Indeed earlier referral has been discouraged by the poor results of tricuspid repair or replacement whose hospital mortality has remained stable around 10%4–7over the years. The current European8 and American9 Guidelines for the management of valvular disease provide somehow different recommendations for isolated tricuspid surgery. The American guidelines tend to be more conservative and suggest waiting for signs or symptoms of “right heart failure” before recommending tricuspid repair (TVr) or replacement (TVR) (class IIa or IIb depending on the etiology). In asymptomatic patients with primary severe isolated TR and progressive RV dilation/dysfunction only a class IIb recommendation is given. Unfortunately, in severe isolated TR, “persisting symptoms” usually develop only in advanced stages of the disease being mainly the clinical manifestation of right ventricular failure, with organ damage and hepato-renal syndrome10. These patients face high morbidity and mortality after surgery, further fuelling the belief of TV surgery being a high-risk procedure. On the other hand, European Guidelines strongly support an earlier surgical referral, even in asymptomatic patients, with initial RV dilation/dysfunction to achieve low hospital mortality and better postoperative outcome8. Indeed, the surgical act of tricuspid repair or replacement is not technically demanding in itself and the outcome is therefore almost exclusively depending on the baseline patient’s profile. The absence of a validated risk score for such surgical procedures, poses further uncertainty regarding the best management of these patients and the correct timing of intervention11–14. A better understanding of the baseline characteristics of patients who experience a regular versus a non-regular postoperative course can help the decision-making regarding the surgical timing of those challenging cases.
The aim of this study was to better define the profile of patients who had a smooth versus a complicated postoperative course following isolated tricuspid valve surgery, in order to try to identify predictors of a favourable or unfavourable in-hospital outcome.