Tricuspid valve replacement: clinical long-term results for acquired isolated tricuspid valve regurgitation.
OBJECTIVE
Acquired isolated tricuspid valve insufficiency (TVI) is a rare condition, and tricuspid valve replacement (TVR) is reserved for those patients in whom operative repair is not possible. The long-term follow up of patients who underwent isolated TVR at the authors' institution was analyzed.


METHODS
All patients (n = 107) who underwent TVR between January 1985 and December 2002 were identified from a clinical database. Among 87 multiple valve replacements, 20 consecutive patients (12 females, eight males; mean age 52.4 years) were encountered who underwent TVR for acquired isolated TVI. Preoperative and perioperative data were recorded retrospectively. The patients and/or their physicians were contacted directly to determine long-term outcome; the follow up was 100% complete.


RESULTS
The mean follow up period was 40.8 months (range: 1-211 months). The cause of TVI was endocarditis (n = 6) or trauma (n = 1); two patients suffered from hypertrophic non-obstructive cardiomyopathy, and one patient had endomyocardial fibrosis. TVI was related to constrictive pericarditis (n = 1) and to prior heart transplantation (n = 3). Seven patients were in NYHA functional classes I/II, and 13 were in classes III/IV. TVR was performed with either a mechanical valve (n = 15) or a bioprosthesis (n = 5). One patient (5%) died perioperatively, and five (25%) died during the follow up period. Two patients underwent a redo-operation during follow up, one due to prosthetic endocarditis, and one after thrombosis of a mechanical prosthesis. There was no structural deterioration of biological prostheses, and no bleeding due to anticoagulation with mechanical prostheses. Among the surviving patients, 13 were in NYHA class I, and one was in class II/III at the time of follow up.


CONCLUSIONS
Isolated TVR for acquired TVI is rarely performed. Among the present patients, perioperative mortality and morbidity were lower than previously reported in the literature. The long-term outcome appeared to be largely dependent on the etiology of the regurgitation.
Maleszka
Ariane
A
Department of Thoracic- and Cardiovascular Surgery, Heart Center Northrhine-Westfalia, Bad Oeynhausen, Germany. Ariane.Maleszka@ruhr-uni-bochum.de
Kleikamp
Georg
G
Koerfer
Reiner
R
D000328:Adult; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000601:surgery*