Analysis of risk factors for prolonged mechanical ventilation in perioperative period of simple tricuspid valve surgery
TIAN Shu-ming
JIN Yan
YIN Zong-tao
ZHAO Yang
LIU Yu
DU Ye-jun
Abstract：Objective This study aimed to investigate the risk factors associated with prolonged mechanical ventilation(PMV)duration following simple tricuspid valve surgery.The findings are intended to optimize surgical timing,enhance perioperative success rates,and improve patient prognosis.Methods A total of 158 patients who underwent simple tricuspid valvuloplasty or replacement surgery at department of cardiovascular surgery,General Hospital of Northen Theater Command,from January 2006 to October 2023 were included.Patients were divided into two groups:those requiring PMV(n=54)and those not requiring PMV(n=104),based on whether the duration of postoperative mechanical ventilation exceeded 24 hours.Results Among the 158 patients,109 underwent tricuspid valve replacement while 49 underwent tricuspid valvuloplasty,with no significant differences observed between the two groups.Univariate analysis indicated no significant statistical differences regarding secondary surgery rate,extracorporeal circulation time,liver function,brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),atrial diameter,right ventricular diameter,inferior vena cava diameter,and inspiratory rate(all P>0.05).However,patients in the PMV group were significantly older than those in the non-PMV group[(51.93±15.09)years vs.(59.78±10.25)years,P=0.027)and there was a higher proportion of females in PMV group compared to males(P=0.024).The incidence of preoperative atrial fibrillation in PMV group was significantly greater in PMV group(41%vs.34%,P=0.048),as was the prevalence of preoperative abnormal renal function was significantly higher than that in non-PMV group(P=0.001).Additionally,the preoperative right ventricular area change rate(RVFAC)was significantly lower in the PMV group compared to the non-PMV group[(36.43±4.23)%vs.(31.49±3.68)%,P=0.046],and the preoperative systolic displacement of the tricuspid annulus(TAPSE)was also significantly reduced in the non-PMV group[(15.14±4.89)mm vs.(9.53±6.36)mm,P=0.025].Furthermore,the preoperative peak systolic velocities at the lateral wall of the tricuspid annulus and the ventricular septum(TDIIVSs'and TDITVs')were significantly lower than in the non-PMV group[(8.46±2.64)cm/s vs.(6.63±1.85)cm/s,(12.44±4.53)cm/s vs.(9.13±3.36)cm/s,P=0.004 and 0.003].Multivariate analysis identified elevated preoperative creatinine levels and TDITVs'as significant risk factors for prolonged postoperative mechanical ventilation duration.With TDITVs'demonstrating notable predictive value for PMV after tricuspid valve surgery(AUC=0.80).Specifically,TDITVs≤11.65 cm/s were associated with an increased risk of postoperative PMV.Conclusion Reduced right ventricular systolic function is identified as a risk factor for prolonged mechanical ventilation in patients undergoing surgery for tricuspid regurgitation.Long-term follow-up of TDITVs can aid in determining the optimal timing for surgical intervention in these patients.
Keywords：Tricuspid regurgitationTricuspid valve insufficiencyMechanical ventilation timeRisk factorsRight ventricular systolic functionPeak systolic velocities at the tricuspid valve annulus sidewall
Publication Date：2026-01-25
Online Publishing Date：2026-02-04(First online date of this platform, not the publication date of the document)
Pages：6( 24-29 )