First exploration of postoperative pulmonary complications after transcatheter tricuspid valve replacement and recommendations for rehabilitation: A prospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Yuqiang ¹ , SHI Jun ¹ , LIU Lulu ¹ , LUO Zeruxin ² , ZHANG Fengmei ¹ , GUO Yingqiang ¹ ,  YU Pengming ^2,3

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, 610041, P. R. China;

Corresponding author：

YU Pengming, Email: 13438201451@126.com

Keywords：

Transcatheter tricuspid valve replacement; postoperative pulmonary complications; tricuspid regurgitation; prerehabilitation; prospective cohort study

DOI：

10.7507/1007-4848.202111038

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Objective To investigate the morbidity of postoperative pulmonary complications (PPCs) in patients after transcatheter tricuspid valve replacement (TTVR). Methods A prospective cohort study enrolled 19 patients who were diagnosed with severe or greater tricuspid regurgitation in West China Hospital from October 11, 2020 to March 1, 2021, and would receive TTVR using LuX-valve for valve replacement. The patients were divided into a PPCs group and a non-PPCs group according to the presence of PPCs. The incidence of PPCs after tricuspid valve intervention between the two groups was compared. Results Of 19 patients diagnosed with severe or greater tricuspid regurgitation registered in the database, 17 met the inclusion criteria, including 15 females and 2 males, with a mean age of 68.4±8.0 years. PPCs occurred in 9 of 17 (52.9%) patients. At discharge, compared with the non-PPCs group, the PPCs group had a longer postoperative hospital stay [11.0 (10.0, 17.0) d vs. 7.5 (7.0, 8.0) d, P=0.01], longer ICU stay [72.0 (45.5, 95.0) h vs. 20.5 (16.0, 22.8) h, P<0.01], and more hospital cost [74.3 (65.9, 98.3) thousand yuan vs. 52.6 (44.2, 57.4) thousand yuan, P<0.01]. At 30 days of follow-up, the PPCs group was found that the rate of New York Heart Association cardiac function≥class Ⅲ (66.7% vs. 12.5%, P<0.01) was higher, the six-minute walk distance (170.2±169.3 m vs. 377.9±80.5 m, P<0.01) was shorter and Kansas City Cardiomyopathy Questionnaire heart failure score (40.9±31.2 vs. 80.4±5.8, P<0.01) was less than those of the non-PPCs group. Conclusion PPCs are common in the patients undergoing TTVR and severely affect patients' cardiac function, exercise function and quality-of-life recovery. Proactive preoperative intervention as well as early postoperative rehabilitation management should be provided to those at high risk of PPCs.

Citation： WANG Yuqiang, SHI Jun, LIU Lulu, LUO Zeruxin, ZHANG Fengmei, GUO Yingqiang, YU Pengming. First exploration of postoperative pulmonary complications after transcatheter tricuspid valve replacement and recommendations for rehabilitation: A prospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(8): 963-970. doi: 10.7507/1007-4848.202111038 Copy

1.	Stuge O, Liddicoat J. Emerging opportunities for cardiac surgeons within structural heart disease. J Thorac Cardiovasc Surg, 2006, 132(6): 1258-1261.
2.	Prihadi EA, van der Bijl P, Gursoy E, et al. Development of significant tricuspid regurgitation over time and prognostic implications: New insights into natural history. Eur Heart J, 2018, 39(39): 3574-3581.
3.	Asmarats L, Puri R, Latib A, et al. Transcatheter tricuspid valve interventions: Landscape, challenges, and future directions. J Am Coll Cardiol, 2018, 71(25): 2935-2956.
4.	Axtell AL, Bhambhani V, Moonsamy P, et al. Surgery does not improve survival in patients with isolated severe tricuspid regurgitation. J Am Coll Cardiol, 2019, 74(6): 715-725.
5.	Fam NP, Braun D, von Bardeleben RS, et al. Compassionate use of the PASCAL transcatheter valve repair system for severe tricuspid regurgitation: A multicenter, observational, first-in-human experience. JACC Cardiovasc Interv, 2019, 12(24): 2488-2495.
6.	Asmarats L, Perlman G, Praz F, et al. Long-term outcomes of the FORMA transcatheter tricuspid valve repair system for the treatment of severe tricuspid regurgitation: Insights from the first-in-human experience. JACC Cardiovasc Interv, 2019, 12(15): 1438-1447.
7.	Strosing KM, Faller S, Gyllenram V, et al. Inhaled anesthetics exert different protective properties in a mouse model of ventilator-induced lung injury. Anesth Analg, 2016, 123(1): 143-151.
8.	Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
9.	Hahn RT, Zamorano JL. The need for a new tricuspid regurgitation grading scheme. Eur Heart J Cardiovasc Imaging, 2017, 18(12): 1342-1343.
10.	Kroenke K, Lawrence VA, Theroux JF, et al. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med, 1992, 152(5): 967-971.
11.	Chumillas S, Ponce JL, Delgado F, et al. Prevention of postoperative pulmonary complications through respiratory rehabilitation: A controlled clinical study. Arch Phys Med Rehabil, 1998, 79(1): 5-9.
12.	Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM Joint Taskforce on Perioperative Outcome Measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
13.	Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.
14.	ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
15.	Planer D, Beeri R, Danenberg HD. First-in-human transcatheter tricuspid valve repair: 30-day follow-up experience with the mistral device. JACC Cardiovasc Interv, 2020, 13(18): 2091-2096.
16.	Muntané-Carol G, Alperi A, Faroux L, et al. Transcatheter interventions for tricuspid valve disease: What to do and who to do it on. Can J Cardiol, 2021, 37(7): 953-967.
17.	Hahn RT, Meduri CU, Davidson CJ, et al. Early feasibility study of a transcatheter tricuspid valve annuloplasty: SCOUT trial 30-day results. J Am Coll Cardiol, 2017, 69(14): 1795-1806.
18.	Taramasso M, Hahn RT, Alessandrini H, et al. The International Multicenter TriValve Registry: Which patients are undergoing transcatheter tricuspid repair? JACC Cardiovasc Interv, 2017, 10(19): 1982-1990.
19.	Perlman G, Praz F, Puri R, et al. Transcatheter tricuspid valve repair with a new transcatheter coaptation system for the treatment of severe tricuspid regurgitation: 1-year clinical and echocardiographic results. JACC Cardiovasc Interv, 2017, 10(19): 1994-2003.
20.	Nickenig G, Kowalski M, Hausleiter J, et al. Transcatheter treatment of severe tricuspid regurgitation with the edge-to-edge MitraClip technique. Circulation, 2017, 135(19): 1802-1814.
21.	Braun D, Nabauer M, Orban M, et al. Transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique. EuroIntervention, 2017, 12(15): e1837-e1844.
22.	Taramasso M, Alessandrini H, Latib A, et al. Outcomes after current transcatheter tricuspid valve intervention: Mid-term results from the International TriValve Registry. JACC Cardiovasc Interv, 2019, 12(2): 155-165.
23.	Nickenig G, Weber M, Schueler R, et al. 6-month outcomes of tricuspid valve reconstruction for patients with severe tricuspid regurgitation. J Am Coll Cardiol, 2019, 73(15): 1905-1915.
24.	Nickenig G, Weber M, Lurz P, et al. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet, 2019, 394(10213): 2002-2011.
25.	Lu FL, Ma Y, An Z, et al. First-in-man experience of transcatheter tricuspid valve replacement with LuX-Valve in high-risk tricuspid regurgitation patients. JACC Cardiovasc Interv, 2020, 13(13): 1614-1616.
26.	Kitamura M, Fam NP, Braun D, et al. 12-month outcomes of transcatheter tricuspid valve repair with the PASCAL system for severe tricuspid regurgitation. Catheter Cardiovasc Interv, 2021, 97(6): 1281-1289.
27.	Kodali S, Hahn RT, Eleid MF, et al. Feasibility study of the transcatheter valve repair system for severe tricuspid regurgitation. J Am Coll Cardiol, 2021, 77(4): 345-356.
28.	Davidson CJ, Lim DS, Smith RL, et al. Early feasibility study of cardioband tricuspid system for functional tricuspid regurgitation: 30-day outcomes. JACC Cardiovasc Interv, 2021, 14(1): 41-50.
29.	World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 2013, 310(20): 2191-2194.
30.	Brooks-Brunn JA. Postoperative atelectasis and pneumonia: Risk factors. Am J Crit Care, 1995, 4(5): 340-349.
31.	Brocki BC, Andreasen JJ, Langer D, et al. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: A randomized controlled trial. Eur J Cardiothorac Surg, 2016, 49(5): 1483-1491.
32.	Khan NA, Quan H, Bugar JM, et al. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med, 2006, 21(2): 177-180.
33.	Awdeh H, Kassak K, Sfeir P, et al. The SF-36 and 6-minute walk test are significant predictors of complications after major surgery. World J Surg, 2015, 39(6): 1406-1412.
34.	Keeratichananont W, Thanadetsuntorn C, Keeratichananont S. Value of preoperative 6-minute walk test for predicting postoperative pulmonary complications. Ther Adv Respir Dis, 2016, 10(1): 18-25.
35.	Odor PM, Bampoe S, Gilhooly D, et al. Perioperative interventions for prevention of postoperative pulmonary complications: Systematic review and meta-analysis. BMJ, 2020, 368: m540.
36.	Serpa Neto A, Hemmes SN, Barbas CS, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: A systematic review and meta-analysis. Lancet Respir Med, 2014, 2(12): 1007-1015.
37.	Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med, 2013, 369(5): 428-437.
38.	Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev, 2015, (10): CD010356.
39.	McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med, 2017, 27(6): 420-425.

1. Stuge O, Liddicoat J. Emerging opportunities for cardiac surgeons within structural heart disease. J Thorac Cardiovasc Surg, 2006, 132(6): 1258-1261.
2. Prihadi EA, van der Bijl P, Gursoy E, et al. Development of significant tricuspid regurgitation over time and prognostic implications: New insights into natural history. Eur Heart J, 2018, 39(39): 3574-3581.
3. Asmarats L, Puri R, Latib A, et al. Transcatheter tricuspid valve interventions: Landscape, challenges, and future directions. J Am Coll Cardiol, 2018, 71(25): 2935-2956.
4. Axtell AL, Bhambhani V, Moonsamy P, et al. Surgery does not improve survival in patients with isolated severe tricuspid regurgitation. J Am Coll Cardiol, 2019, 74(6): 715-725.
5. Fam NP, Braun D, von Bardeleben RS, et al. Compassionate use of the PASCAL transcatheter valve repair system for severe tricuspid regurgitation: A multicenter, observational, first-in-human experience. JACC Cardiovasc Interv, 2019, 12(24): 2488-2495.
6. Asmarats L, Perlman G, Praz F, et al. Long-term outcomes of the FORMA transcatheter tricuspid valve repair system for the treatment of severe tricuspid regurgitation: Insights from the first-in-human experience. JACC Cardiovasc Interv, 2019, 12(15): 1438-1447.
7. Strosing KM, Faller S, Gyllenram V, et al. Inhaled anesthetics exert different protective properties in a mouse model of ventilator-induced lung injury. Anesth Analg, 2016, 123(1): 143-151.
8. Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology, 2019, 131(5): 1046-1062.
9. Hahn RT, Zamorano JL. The need for a new tricuspid regurgitation grading scheme. Eur Heart J Cardiovasc Imaging, 2017, 18(12): 1342-1343.
10. Kroenke K, Lawrence VA, Theroux JF, et al. Operative risk in patients with severe obstructive pulmonary disease. Arch Intern Med, 1992, 152(5): 967-971.
11. Chumillas S, Ponce JL, Delgado F, et al. Prevention of postoperative pulmonary complications through respiratory rehabilitation: A controlled clinical study. Arch Phys Med Rehabil, 1998, 79(1): 5-9.
12. Jammer I, Wickboldt N, Sander M, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: A statement from the ESA-ESICM Joint Taskforce on Perioperative Outcome Measures. Eur J Anaesthesiol, 2015, 32(2): 88-105.
13. Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth, 2017, 118(3): 317-334.
14. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
15. Planer D, Beeri R, Danenberg HD. First-in-human transcatheter tricuspid valve repair: 30-day follow-up experience with the mistral device. JACC Cardiovasc Interv, 2020, 13(18): 2091-2096.
16. Muntané-Carol G, Alperi A, Faroux L, et al. Transcatheter interventions for tricuspid valve disease: What to do and who to do it on. Can J Cardiol, 2021, 37(7): 953-967.
17. Hahn RT, Meduri CU, Davidson CJ, et al. Early feasibility study of a transcatheter tricuspid valve annuloplasty: SCOUT trial 30-day results. J Am Coll Cardiol, 2017, 69(14): 1795-1806.
18. Taramasso M, Hahn RT, Alessandrini H, et al. The International Multicenter TriValve Registry: Which patients are undergoing transcatheter tricuspid repair? JACC Cardiovasc Interv, 2017, 10(19): 1982-1990.
19. Perlman G, Praz F, Puri R, et al. Transcatheter tricuspid valve repair with a new transcatheter coaptation system for the treatment of severe tricuspid regurgitation: 1-year clinical and echocardiographic results. JACC Cardiovasc Interv, 2017, 10(19): 1994-2003.
20. Nickenig G, Kowalski M, Hausleiter J, et al. Transcatheter treatment of severe tricuspid regurgitation with the edge-to-edge MitraClip technique. Circulation, 2017, 135(19): 1802-1814.
21. Braun D, Nabauer M, Orban M, et al. Transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique. EuroIntervention, 2017, 12(15): e1837-e1844.
22. Taramasso M, Alessandrini H, Latib A, et al. Outcomes after current transcatheter tricuspid valve intervention: Mid-term results from the International TriValve Registry. JACC Cardiovasc Interv, 2019, 12(2): 155-165.
23. Nickenig G, Weber M, Schueler R, et al. 6-month outcomes of tricuspid valve reconstruction for patients with severe tricuspid regurgitation. J Am Coll Cardiol, 2019, 73(15): 1905-1915.
24. Nickenig G, Weber M, Lurz P, et al. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet, 2019, 394(10213): 2002-2011.
25. Lu FL, Ma Y, An Z, et al. First-in-man experience of transcatheter tricuspid valve replacement with LuX-Valve in high-risk tricuspid regurgitation patients. JACC Cardiovasc Interv, 2020, 13(13): 1614-1616.
26. Kitamura M, Fam NP, Braun D, et al. 12-month outcomes of transcatheter tricuspid valve repair with the PASCAL system for severe tricuspid regurgitation. Catheter Cardiovasc Interv, 2021, 97(6): 1281-1289.
27. Kodali S, Hahn RT, Eleid MF, et al. Feasibility study of the transcatheter valve repair system for severe tricuspid regurgitation. J Am Coll Cardiol, 2021, 77(4): 345-356.
28. Davidson CJ, Lim DS, Smith RL, et al. Early feasibility study of cardioband tricuspid system for functional tricuspid regurgitation: 30-day outcomes. JACC Cardiovasc Interv, 2021, 14(1): 41-50.
29. World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 2013, 310(20): 2191-2194.
30. Brooks-Brunn JA. Postoperative atelectasis and pneumonia: Risk factors. Am J Crit Care, 1995, 4(5): 340-349.
31. Brocki BC, Andreasen JJ, Langer D, et al. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: A randomized controlled trial. Eur J Cardiothorac Surg, 2016, 49(5): 1483-1491.
32. Khan NA, Quan H, Bugar JM, et al. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gen Intern Med, 2006, 21(2): 177-180.
33. Awdeh H, Kassak K, Sfeir P, et al. The SF-36 and 6-minute walk test are significant predictors of complications after major surgery. World J Surg, 2015, 39(6): 1406-1412.
34. Keeratichananont W, Thanadetsuntorn C, Keeratichananont S. Value of preoperative 6-minute walk test for predicting postoperative pulmonary complications. Ther Adv Respir Dis, 2016, 10(1): 18-25.
35. Odor PM, Bampoe S, Gilhooly D, et al. Perioperative interventions for prevention of postoperative pulmonary complications: Systematic review and meta-analysis. BMJ, 2020, 368: m540.
36. Serpa Neto A, Hemmes SN, Barbas CS, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: A systematic review and meta-analysis. Lancet Respir Med, 2014, 2(12): 1007-1015.
37. Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med, 2013, 369(5): 428-437.
38. Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev, 2015, (10): CD010356.
39. McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med, 2017, 27(6): 420-425.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

First exploration of postoperative pulmonary complications after transcatheter tricuspid valve replacement and recommendations for rehabilitation: A prospective cohort study

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