| Affiliation: | 1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN;2. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN;3. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN;2. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN;3. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN;1. Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;2. Cardiovascular Program, ICES, Toronto, Ontario, Canada;3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;4. Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY;5. Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada;1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota;2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota;1. Stanford University School of Medicine, Palo Alto, CA;2. American Medical Association, Chicago, IL;3. Mayo Clinic, Rochester, MN |
| Abstract: | ObjectiveTo evaluate outcomes of elective surgical management of tricuspid regurgitation (TR) in patients with transvenous right ventricular leads, and compare results between non–lead-induced and lead-induced TR patients.Patients and MethodsWe studied patients with right ventricular leads who underwent tricuspid valve surgery from January 1, 1993, through December 31, 2015, and categorized them as non–lead-induced and lead-induced TR. Propensity score (PS) for the tendency to have lead-induced TR was estimated from logistic regression and was used to adjust for group differences.ResultsFrom the initial cohort of 470 patients, 444 were included in PS-adjustment analyses (174 non–lead-induced TRs 123 repairs, 51 replacements], 270 lead-induced TRs 129 repairs, 141 replacements]). In PS-adjusted multivariable analysis, lead-induced TR was not associated with mortality (P=.73), but tricuspid valve replacement was (hazard ratio, 1.59; 95% CI, 1.13 to 2.25; P=.008). Five-year freedom from tricuspid valve re-intervention was 100% for non–lead-induced TR and 92.3% for lead-induced TR; rates adjusted for PS differed between groups (P=.005). There was significant improvement in TR postoperatively in each group (P<.001). In patients having tricuspid valve repair, TR grades tended to worsen over time, but the difference in trends was not significantly different between groups.ConclusionLead-induced TR did not affect long-term survival after elective tricuspid valve surgery. In patients with lead-induced TR, tricuspid valve re-intervention was more common. Improvement in TR was achieved in both groups after surgery; however, severity of TR tended to increase over follow-up after tricuspid valve repair. |
