Functional Tricuspid Regurgitation Repair at the time of Left-Sided Valve Surgery. the Impact on the Cardiac Rehabilitation Program

Abstract

Objective: to compare the early post-operative functional status and the efficacy of the cardiac rehabilitation program (CRP) after isolated left-sided valvular surgery or with concomitant tricuspid valve repair (TVR). Methods: we retrospectively enrolled patients admitted to the Cardiac Rehabilitation Unit of our institution from January 2014 to January 2019, following mitral or aortic valve surgery. In agreement with current guidelines, concomitant tricuspid annuloplasty was added to patients with severe functional tricuspid regurgitation (TR) and in those with mild to moderate TR when annulus dilatation was present. A 6-minute walk test (6mWT) was performed within the second day of admission and repeated predischarge. The distances walked on the 6mWT were reported as absolute value and as a percentage of the predicted value, taking into account anthropometric variables. Changes in the 6mWT performance and Barthel index (BI) were assessed to evaluate the impact of CRP on exercise tolerance and functional independence, respectively. Results: of 117 patients, 62 (53%) had isolated left-sided valvular surgery and 55 (47%) had concomitant TVR. There were no significant differences between the two groups in the baseline 6mWT performance and its improvement at the end of CRP. TVR was associated with a worse BI on admission, but with a greater improvement after the CRP and a pre-discharge BI comparable to isolated left-sided surgery. Upon linear regression analysis, diabetes and chronic renal disease were predictors of the baseline 6mWT performance. Conclusion: TVR does not affect the early post-operative functional status and the efficacy of the CRP after valvular surgery

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