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A scoring system for predicting outcomes of tricuspid valve surgery, developed from a limited database, was only modestly accurate but could be a good first step.
The model, developed by comparing the 9% of patients in the database who died during or within 30 days of tricuspid surgery to those who didn't, had an area under the curve of 0.74, , of the University of Virginia in Charlottesville, and colleagues found.
Action Points
- This study was presented as an abstract or poster at a meeting. Its contents should be considered preliminary until it is published in a peer-reviewed journal.
For major morbidity, the same model had an area under the curve of 0.76, they reported at the in Phoenix.
Factors included were age, sex, prior stroke, hemodialysis, chronic lung disease, New York Heart Association class, reoperation, and urgent versus emergent status of the procedure.
Progressively higher risk scores were associated with progressively higher mortality and major morbidity risk.
Such a score to estimate risk of open tricuspid valve surgery hasn't been available and would be helpful, commented , chief of cardiovascular surgery at the University of Pennsylvania Medical Center in Philadelphia, who served as a discussant at the presentation.
"Right now people use many of these factors that were elucidated based on clinical experience," he told 51˶. "Most clinicians would really focus on right ventricular function and liver function to amplify this score."
The score could also play a role as percutaneous tricuspid valve replacement systems are developed, Acker predicted.
"Such a clinical risk score would be helpful in evaluating new technology going forward, such as percutaneous valves to see if these could improve on estimated risk for open surgery," he said.
The study included 2,050 isolated tricuspid valve operations done from 2002 through 2014 at centers voluntarily participating in the Virginia Cardiac Surgery Quality Initiative and Michigan Society of Thoracic and Cardiovascular Surgeons and submitting data to the STS database.
Acker noted that expanding to the entire STS database beyond the two states involved in this study might be a good next step.
The researchers also cautioned that, as an observational study, it might have been subject to selection bias, and that the results were constrained by the STS definitions without sufficient data on right ventricular function, degree of liver dysfunction, or tricuspid valve etiology.
"A simple clinical risk score predicts mortality and morbidity to better stratify patient risk for tricuspid valve surgery," LaPar's group concluded, adding that "Early referral for surgical intervention for isolated tricuspid valve disease should be encouraged to minimize surgical risk."
From the American Heart Association:
Primary Source
Society of Thoracic Surgeons
LaPar DJ, et al "Development of a risk prediction model and clinical risk score for isolated tricuspid valve surgery: An STS database analysis" STS 2016.