Tricuspid surgery at time of mitral surgery improves survival free from severe tricuspid regurgitation but not quality of lifeCentral MessagePerspective

Objective: The choice to operate on moderate tricuspid regurgitation (TR) during mitral surgery is challenging owing to limited mid-term data. We assess whether concomitant tricuspid operations improve mid-term quality of life, morbidity, or mortality. Methods: An institutional database identified mitral surgery recipients with moderate TR at the time of surgery from 2010 to 2019. Patients were stratified by the presence of a concomitant tricuspid operation. Quality of life at the last follow-up was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). Morbidity was compared using the χ2 test, Mann-Whitney U test, and Student t test. Survival was analyzed with Kaplan-Meier estimation. Results: Of 210 mitral surgery recipients, 67 (31.9%) underwent concomitant tricuspid surgery. The concomitant tricuspid surgery cohort had greater preoperative dialysis use (10.5% vs 3.5%; P = .043) but similar age, New York Heart Association class, and cardiac surgery history relative to the nonconcomitant cohort (P > .05 for all). The concomitant tricuspid surgery cohort had a longer cardiopulmonary bypass time (144 minutes vs 122 minutes; P = .005) but a similar rate of mitral repair (P = .220). Postoperative KCCQ-12 scores reflected high quality of life in both cohorts (95.1 vs 89.1; P = .167). The concomitant tricuspid surgery cohort trended toward a higher perioperative pacemaker placement rate (22.8% vs 12.7%; P = .088) but were less likely to develop severe TR (0.0% vs 13.0%; P = .004). Overall survival was comparable between the 2 cohorts at 1 year (84.9% vs 81.6%; P = .628) and 5 years (73.5% vs 57.9%; P = .078). Five-year survival free from severe TR was higher in the concomitant cohort (73.5% vs 54.3%; P = .032). Conclusions: Concomitant tricuspid surgery for moderate TR is associated with increased 5-year survival free from severe TR but not with increased quality of life

Temporary mechanical circulatory support as a bridge to transplant in peripartum cardiomyopathy

Background: Use of temporary mechanical circulatory support (tMCS) for peripartum cardiomyopathy (PPCM) shock has been described in small cohorts, but not on a national scale. This study compares tMCS, durable MCS (dMCS), and no MCS as bridge to transplant strategies for PPCM. Methods: Female patients ≥14 years, listed for first-time isolated heart transplant (HT) between January 1, 2000 and June 30, 2021, were identified in the United Network for Organ Sharing database. Patients were stratified by receipt of MCS at any point during the waitlist period. Patients on multiple devices were excluded. Results: A total of 1,043 PPCM patients were listed for HT, including 575 bridged on no MCS, 177 on tMCS, and 291 on dMCS. The tMCS cohort included 10 patients on extracorporeal membrane oxygenation, 113 on intra-aortic balloon pump, and 54 on nondischargeable ventricular assist device (VAD) or percutaneous device. The dMCS group primarily received durable VADs. Compared to dMCS, tMCS recipients were more likely to require inotropes, mechanical ventilation, and longer hospitalizations pretransplant (all p  0.05). After multivariable risk adjustment, neither tMCS (adjusted hazard ratio 0.56 [0.06-5.43]) nor dMCS (adjusted hazard ratio 0.36 [0.05-2.82]) significantly predicted 3-year graft survival. Conclusions: Compared to patients bridged to HT on dMCS or no MCS, PPCM patients receiving tMCS are higher acuity candidates but have equivalent post-transplant graft survival