title: Short- and long-term results of triple valve surgery in the modern era.
abstract: BACKGROUND
  Triple valve surgery is usually complex and carries a reported operative mortality of 25% and 10-year survival of 40%. We examined surgical results in the modern era.
  
  
  METHODS
  A total of 174 consecutive patients, mean age 58 +/-12 years underwent triple valve surgery from 1990 to 2004. The most common aortic and mitral valve disease was rheumatic disease (61%), followed by prosthetic valve dysfunction (22%). Tricuspid valve disease was functional regurgitation in 72% of patients. Ninety-four percent of patients were in New York Heart Association class III and IV, and 60% had had previous cardiac operations. The aortic valve procedures consisted of 160 replacements and 14 repairs, the mitral valve procedures, 153 replacements and 21 repairs, and the tricuspid valve procedures, 12 replacements and 162 repairs. Univariate and multivariable analyses were performed to identify predictors of early and late survival.
  
  
  RESULTS
  Operative mortality was 13% (n = 22). Univariate factors associated with mortality included urgent surgery, shock, tricuspid valve replacement, preoperative renal failure, and peripheral vascular disease. Survival at 5 and 10 years was 75% and 61%, respectively. Seventy-three percent of patients were in New York Heart Association class I and II at their most recent follow-up. Ten-year freedom from thromboembolism was 88%, from anticoagulation-related hemorrhage, 83%, from endocarditis, 96%, and from cardiac reoperation, 92%.
  
  
  CONCLUSIONS
  Patients with advanced rheumatic valve disease and prosthetic valve dysfunction are at risk for requiring triple valve surgery. Compared with historic reports, the results of triple valve surgery, primary and reoperative, have improved. Although early mortality is high, long-term and event-free survival are comparable with that of patients undergoing single valve replacement.
authors.affiliation: Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Bahaaldin
authors.initials: B
authors.lastname: Alsoufi
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Manjula
authors.initials: M
authors.lastname: Maganti
authors.forename: Susan
authors.initials: S
authors.lastname: Armstrong
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Feindel
authors.forename: Hugh E
authors.initials: HE
authors.lastname: Scully
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery*; D018572:Disease-Free Survival; D004696:Endocarditis / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data; D012214:Rheumatic Heart Disease / Q000601:surgery; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*
chemical_list: D000925:Anticoagulants