title: Long-term outcomes of tricuspid valve replacement in the current era.
abstract: BACKGROUND
  Regardless of the indication, tricuspid valve replacement (TVR) has historically been associated with high mortality and morbidity. We report the results of our experience in a high-risk patient population with an emphasis on operative mortality, long-term survival, and valve related events according to the type of prosthesis.
  
  
  METHODS
  Between 1985 and 1999 TVR was performed in 81 patients (isolated n = 25, combined with valve surgery n = 44, combined with CABG or other n = 12). The mean age was 61 years old (range 19-83 years old). Risk factors included New York Heart Association functional class III/IV (n = 73, 90%), reoperation (n = 58, 72%), urgent/emergent indication (n = 62, 76%), and hepatic dysfunction (n = 13, 16%). Mean pulmonary artery pressure was 34 mmHg. Etiology of tricuspid regurgitation was classified as functional (n = 18, 22%) or organic (n = 52, 64%), or failed previous tricuspid valve surgery (n = 11, 14%).
  
  
  RESULTS
  Tricuspid valve replacement was performed with either a bioprosthetic (n = 34, 42%) or mechanical valve (n = 47, 58%). The overall operative mortality was 22% (n = 18). Risk factors for mortality included urgent/emergent status, age greater than 50 years old, functional etiology, and elevated pulmonary artery pressure. Of the 60 survivors, 26 (43%) died during follow up. After univariate analysis, organic etiology was the only predictor of late death (p = 0.01). Kaplan-Meier survival at 2.5, 5, and 10 years was 80%, 60%, and 45% for bioprosthetic, and 84%, 69%, and 59% for mechanical valves, respectively.
  
  
  CONCLUSIONS
  Patients requiring TVR are typically high-risk with a high-percentage of reoperations, concomitant cardiac procedures, and end-stage functional class. Operative and overall mortality remains high. Heart failure was the predominant cause of early and late deaths, emphasizing importance of timely referral before the development of end-stage cardiac impairment.
authors.affiliation: Mount Sinai Hospital, New York, New York, USA. farzan.filsoufi@mountsinai.org
authors.forename: Farzan
authors.initials: F
authors.lastname: Filsoufi
authors.forename: Ani C
authors.initials: AC
authors.lastname: Anyanwu
authors.forename: Sacha P
authors.initials: SP
authors.lastname: Salzberg
authors.forename: Tim
authors.initials: T
authors.lastname: Frankel
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis / Q000706:statistics & numerical data; D001900:Boston / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D013923:Thromboembolism / Q000209:etiology; D014261:Tricuspid Valve / Q000601:surgery*