title: Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients.
abstract: OBJECTIVE
  Patients with symptoms of right heart failure due to severe tricuspid regurgitation following a prior operation on left heart valves present a difficult problem. The outcome of tricuspid surgery in this setting is not well defined. We describe a single-center experience of isolated tricuspid valve surgery after prior left heart valve surgery, and analyze potential risk factors for a poor outcome.
  
  
  METHODS
  Thirty-four patients who underwent isolated tricuspid valve operation for severe tricuspid regurgitation following prior valvular surgery for left-sided valve disease between 1980 and 1997 were identified. Charts were reviewed for clinical, echocardiographic, catheterization and surgical data. Follow up of survivors was conducted by telephone to ascertain functional status.
  
  
  RESULTS
  Three patients died in hospital (early mortality rate, 8.8%). At a follow up of 71 +/- 39 months, 13 patients were alive and 21 reached an end-point (three cardiac reoperations, 18 deaths). Event-free actuarial survival at five years was 41.6 +/- 9.2%. Patients who were alive at follow up had a mean NYHA functional class of 2.1 +/- 0.6 compared with 3.4 +/- 0.5 preoperatively; 85% of survivors were symptomatically improved. Predictors of poor outcome were: increased age at the time of tricuspid surgery (p = 0.0007) and higher number of prior cardiac operations (one versus two or three, p-value 0.01, relative risk 3.4). Pulmonary artery systolic pressure, left ventricular ejection fraction, right ventricular function and size, annulus diameter, tricuspid valve pathology, and valve replacement versus repair were not predictive of outcome.
  
  
  CONCLUSIONS
  Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior surgery for left-sided heart valve disease can be performed with acceptable early mortality. There remains a high late mortality that is predicted only by age and the number of previous cardiac operations. However, in this selected group of severely symptomatic patients, significant improvement in symptoms are achieved in the survivors.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Staab
authors.forename: R A
authors.initials: RA
authors.lastname: Nishimura
authors.forename: J A
authors.initials: JA
authors.lastname: Dearani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000209:etiology* / Q000601:surgery*