title: Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease.
abstract: BACKGROUND
  Organic tricuspid valve (TV) disease is uncommon. Few studies have compared TV repair with replacement in these patients. The current study compared midterm outcomes of TV repair versus replacement in a large group of patients with organic tricuspid disease.
  
  
  METHODS
  Two-hundred and fifty patients underwent surgery for organic TV disease at our institution from 1979 to 2003. Clinical and echocardiographic follow-up were obtained, were 99% complete, and were 5.2 +/- 4.1 years long (mean +/- standard deviation).
  
  
  RESULTS
  One hundred and seventy-eight patients (71%) underwent TV repair and 72 (29%) received TV replacement (54 bioprosthetic, 18 mechanical). Repair patients were more likely to have hypertension, rheumatic pathology, or elective surgery. Concomitant procedures included mitral (50% of patients), aortic (26%), and coronary bypass (6%) operations. Perioperative and midterm mortality were higher in the replacement group (both p < 0.001). Cox regression analysis revealed TV replacement as an independent predictor of midterm mortality (hazard ratio: 5.1, 95% confidence interval: 2.9 to 9.1, p < 0.001) and decreased event-free survival (hazard ratio: 2.0, 95% confidence interval: 1.1 to 3.6, p = 0.02). Follow-up echocardiography revealed more moderate to severe tricuspid regurgitation in repair patients (38% vs 5%, p < 0.001), but no difference in New York Heart Association functional class or reoperation rates.
  
  
  CONCLUSIONS
  Tricuspid valve repair is associated with better perioperative, midterm, and event-free survival than TV replacement in patients with organic tricuspid disease. Despite more tricuspid regurgitation in the repair group during follow-up, reoperation rates and functional class were similar. Repair should be performed whenever possible in patients with organic tricuspid disease.
authors.affiliation: Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Singh
authors.forename: Gilbert H L
authors.initials: GH
authors.lastname: Tang
authors.forename: Manjula D
authors.initials: MD
authors.lastname: Maganti
authors.forename: Susan
authors.initials: S
authors.lastname: Armstrong
authors.forename: William G
authors.initials: WG
authors.lastname: Williams
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*