A single-center retrospective study of triple valve surgery: early and midterm outcomes

Abstract

Objectives: Triple valve surgery (TVS) is recognized as a complex surgical procedure, associated with significant rates of morbidity and mortality. The aim of this study is to describe early and midterm outcomes and risk factors for mortality in patients who underwent TVS. Methods: In this retrospective, single-center study, TVS patients from two consecutive cohorts - Trifecta and Freedom Solo Bioprostheses - between July 2009 and December 2019 were included. Survival and need for reoperation were accessed in December 2023. Hospital mortality was defined as in-hospital or within the first 30 days after surgery. Median follow-up was 5 years with a maximum of 14 years. Kaplan-Meier method and Cox Regression were used to study time-to-event outcomes. Results: Our cohort included 115 patients (51% male, mean age 72 ± 8 years), 57% had a preoperative NYHA ≥ III classification and 15% had previous cardiac surgery. Surgery priority was urgent or emergent in 36 patients (31%). There were 17 concomitant CABG (15%) and mean bypass and aortic cross-clamping times were 197 ± 62 and 141 ± 44 minutes, respectively. Tricuspid and mitral valves were repaired in 99% and 50%, respectively. Postoperatively, 16% of the patients developed de novo atrial fibrillation, 1 patient needed a permanent pacemaker and 5 patients performed re-exploration surgery due to bleeding. The median length of hospital stay was 11 days and hospital mortality was 13% (n=15). Excluding early deaths, cumulative survival at 1, 5 and 8 were 94%, 70% and 61%, respectively. Freedom from valve-related reoperation at 1, 5 and 8 years was 94%, 92% and 86%, respectively. Conclusion: This TVS cohort evidenced a high hospital mortality, though lower than reported in older studies. We identified age, male sex, diabetes mellitus, chronic kidney disease and anemia as factors that evidenced higher risk for late mortality after TVS.