title: Tricuspid valve involvement in combined mitral and aortic valve surgery.
abstract: BACKGROUND
  Combined mitral and aortic valve disease requiring surgery may involve the tricuspid valve as well. Our treatment policy is conservative especially for tricuspid regurgitation which is operated on when severe only.
  
  
  METHODS
  A retrospective study was performed at a tertiary and secondary referral center for cardiovascular disease. Over a 15-year period, 65 consecutive patients underwent aortic and mitral surgery with concomitant tricuspid regurgitation and/or stenosis. Fifty-five/65 (85%) patients were in NYHA class III-IV. Fifty-eight/65 (89%) patients had tricuspid regurgitation secondary to right chamber dilatation and 7/65 (11%) had tricuspid stenosis and/or regurgitation because of previous endocarditis. Twenty-two/65 (34%) tricuspid valves were operated on: 18/22 (82%) de Vega annuloplasty, 2/22 (9%) commissurotomies and 2/22 (9%) prosthetic valves. Mortality and complications were recorded during a mean follow-up of 5.3 yrs (range, 6 months-15.3 yrs). Event-free survivals were determined using the Kaplan-Meier method.
  
  
  RESULTS
  Hospital mortality was 6.2% (4/65) and the complication rate was 18.5% (12/65). The freedom from late valve related mortality and morbidity at 5, 10 and 15 years was 86+/-5.5%, 81.9+/-6.8%, and 81.9+/-6.8% respectively. One valve related complication was due to the tricuspid valve. At last follow-up, 87% (47/54) of the survivors were in NYHA class I-II.
  
  
  CONCLUSIONS
  With a conservative policy of tricuspid valve intervention, functional results of this patient population are good and long-term valve related morbidity and mortality are mainly related to the mitral and aortic valve procedures.
authors.affiliation: Clinic for Cardiovascular Surgery, CHUV (Centre Hospitalier Universitaire Vaudois), CH-1011 Lausanne, Switzerland. xavier.mueller@chuv.hospvd.ch
authors.forename: X M
authors.initials: XM
authors.lastname: Mueller
authors.forename: H T
authors.initials: HT
authors.lastname: Tevaearai
authors.forename: F
authors.initials: F
authors.lastname: Stumpe
authors.forename: A P
authors.initials: AP
authors.lastname: Fischer
authors.forename: M
authors.initials: M
authors.lastname: Hurni
authors.forename: P
authors.initials: P
authors.lastname: Ruchat
authors.forename: L K
authors.initials: LK
authors.lastname: von Segesser
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D002315:Cardiopulmonary Bypass; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000209:etiology; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D014264:Tricuspid Valve Stenosis / Q000401:mortality / Q000601:surgery*