Tricuspid valve replacement subsequent to previous open heart surgery.
OBJECTIVE
Earlier surgical intervention to the mitral and/or aortic valve means that it will be uncommon to replace the tricuspid valve (TVR) in a patient who has not had prior open heart surgery.


METHODS
We report the short and medium term results of a consecutive series of 14 patients who underwent bioprosthetic TVR between December 1985 and February 1993 at the Hammersmith Hospital, UK. All patients had undergone previous open heart surgery on at least one occasion. Mean patient age was 59 years (range: 45-77 years), 11 were female and three were male. Ten patients (72%) were in New York Heart Association class III or IV preoperatively, eight patients were first time reoperations and six patients were second time reoperations.


RESULTS
Hospital mortality was 50% (7/14). Of these seven patients, six were in NYHA class III or IV preoperatively, and three were second time reoperations. There were no 'on-the-table deaths' and no patients required reoperation for bleeding or permanent pacing. For the patients discharged from hospital, the mean follow up was 46 months (range 9-84 months) and it was 100% complete. There was no significant difference in the preoperative assessment data between the hospital mortality group and the patients who left hospital (p > 0.05). Of the patients discharged, four (57% of this group, 28.5% of all patients) showed an improvement in NYHA classification and all patients reported a reduction in peripheral edema. Amongst the survivors there was 100% freedom from valve related complications. Within this group there have been three deaths since discharge, all due to biventricular failure.


CONCLUSIONS
From this study we conclude that TVR in patients who have had prior cardiac surgery is a high risk procedure. Nonetheless, amongst survivors, benefit may be gained by either a reduction in peripheral edema and/or an improvement in NYHA class.
Hornick
P
P
Department of Cardiac Surgery, Royal Postgraduate Medical School, London, United Kingdom.
Harris
P A
PA
Taylor
K M
KM
D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D014264:Tricuspid Valve Stenosis / Q000401:mortality / Q000601:surgery*