Journal of thoracic disease · 2026
Effect of diuretic burden and model for end-stage liver disease-sodium score after isolated tricuspid valve surgery.
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Tamagawa Yuki, Yajima Shin, Yoshioka Daisuke, Kawamura Ai, Misumi Yusuke, Hiraoka Arudo, Nakamura Teruya, Hata Masatoshi, Funatsu Toshihiro, Yoshikawa Yasushi, Onohara Takeshi, Monta Osamu, Kitabayashi Katsukiyo, Kondoh Haruhiko, Saito Tetsuya, Kitahara Mutsunori, Matsue Hajime, Hosoba Soh, Sekiya Naosumi, Yokoyama Junya, Iwata Keiji, Ohtani Akinobu, Handa Kazuma, Kumagai Kunitaka, Yanagino Yusuke, Kakizawa Yumi, Ohmori Takahiro, Kawamura Takuji, Saito Shunsuke, Shimamura Kazuo, Miyagawa Shigeru
Аннотация
BACKGROUND: Outcomes after isolated tricuspid valve surgery (ITVS) are strongly influenced by advanced right-sided heart failure and hepatorenal dysfunction; however, the prognostic significance of preoperative diuretic burden remains unclear. This study examined whether preoperative diuretic burden is associated with outcomes after ITVS and whether combining it with the model for end-stage liver disease-sodium (MELD-Na) score improves risk stratification.
METHODS: We retrospectively analyzed 85 patients who underwent ITVS at 16 Japanese hospitals between 2015 and 2024. Diuretic doses were converted to furosemide equivalents. A dose >40 mg/day was defined as high. The primary outcome was 5-year all-cause mortality. The secondary outcome was the composite adverse outcome, which comprised events such as cardiac death, hospitalization for heart failure, and dialysis initiation. Outcomes were compared across four groups defined by diuretic burden and the MELD-Na score.
RESULTS: Patients who received a high dose (high-dose group) had higher 5-year cumulative mortality (57.8% vs. 19.4%; P<0.001) and a higher cumulative incidence of the composite adverse outcome (77.5% vs. 31.3%; P<0.001) than those of patients who received a low dose (low-dose group). The MELD-Na score independently predicted mortality [hazard ratio (HR) =1.11; P=0.045]. Combining diuretic burden and the MELD-Na score showed a stepwise gradient, the highest mortality rate, and the highest incidence of the composite adverse outcome in the high-dose group with high MELD-Na scores. The high-dose group with low MELD-Na scores had poorer outcomes than those of the low-dose group with low MELD-Na scores.
CONCLUSIONS: A higher preoperative diuretic burden is associated with worse outcomes after ITVS. Escalating the diuretic dose to mitigate organ dysfunction does not reliably improve outcomes. Early surgical referral should be considered before dose escalation and organ dysfunction.
METHODS: We retrospectively analyzed 85 patients who underwent ITVS at 16 Japanese hospitals between 2015 and 2024. Diuretic doses were converted to furosemide equivalents. A dose >40 mg/day was defined as high. The primary outcome was 5-year all-cause mortality. The secondary outcome was the composite adverse outcome, which comprised events such as cardiac death, hospitalization for heart failure, and dialysis initiation. Outcomes were compared across four groups defined by diuretic burden and the MELD-Na score.
RESULTS: Patients who received a high dose (high-dose group) had higher 5-year cumulative mortality (57.8% vs. 19.4%; P<0.001) and a higher cumulative incidence of the composite adverse outcome (77.5% vs. 31.3%; P<0.001) than those of patients who received a low dose (low-dose group). The MELD-Na score independently predicted mortality [hazard ratio (HR) =1.11; P=0.045]. Combining diuretic burden and the MELD-Na score showed a stepwise gradient, the highest mortality rate, and the highest incidence of the composite adverse outcome in the high-dose group with high MELD-Na scores. The high-dose group with low MELD-Na scores had poorer outcomes than those of the low-dose group with low MELD-Na scores.
CONCLUSIONS: A higher preoperative diuretic burden is associated with worse outcomes after ITVS. Escalating the diuretic dose to mitigate organ dysfunction does not reliably improve outcomes. Early surgical referral should be considered before dose escalation and organ dysfunction.