Tricuspid valve surgery: a thirty-year assessment of early and late outcome.
OBJECTIVE
Tricuspid valve (TV) surgery is usually performed as a concomitant reconstruction procedure in addition to the correction of other cardiac pathologies. Isolated tricuspid procedures are exceptionally rare. Prosthetic valve replacement is also seldom required. Generally, these patients face a high risk of operative mortality and long-term outcome is poor. In this study we reviewed our experience with TV surgery focusing on risk factors for operative mortality, long-term outcome and incidence of valve related complications.


METHODS
Retrospective analysis of 416 consecutive patients >18 years with acquired TV disease operated on between 1974 and 2003. The follow-up is 97% complete (mean 5.9+/-6.3 years). Three hundred and sixty-six patients (88%) underwent TV surgery with concomitant mitral (n=340) or aortic (n=100) valve surgery. The tricuspid valve was repaired in 310 patients (74.5%) and replaced in 106 (25.5%). A biological prosthesis was used in 68 patients (64%). Mean age at repair and replacement was 61+/-12.5 and 50+/-11.3 years, respectively (p<0.001).


RESULTS
Overall 30-day mortality was 18.8% (78/416) and decreased from 33.3% (1974-1979) to 11.1% (2000-2003) (p< or =0.0001). Thirty-day mortality after TV repair and replacement was 13.9% (43/310) and 33% (35/106), respectively (p< or =0.001). Cox regression analysis revealed TV replacement as an independent predictor of 30-day mortality. Ten-year actuarial survival after TV repair and replacement was 47+/-3.5% and 37+/-4.8%, respectively (p=0.002). Forty-five patients (10.8%) required a TV re-operation after 7.7+/-5.1 years. Freedom from TV re-operation 10 years after TV repair and replacement was 83+/-3.6% and 79+/-6.1%, respectively (p=0.092).


CONCLUSIONS
Patients who require tricuspid valve surgery constitute a high-risk group. Tricuspid valve repair is associated with better perioperative and long-term outcome than valve replacement. However, patients undergoing replacement showed a significant higher incidence of risk factors for operative mortality. The incidence of re-operation is low with no significant difference when the tricuspid valve has been repaired or replaced. When valve replacement is necessary we recommend the use of a biological prosthesis considering the poor long-term survival.
Guenther
Thomas
T
Department of Cardiovascular Surgery, German Heart Center, Clinic at the Technical University-Munich, Lazarettstrasse 36, Munich, Germany. Guenther@dhm.mhn.de
Noebauer
Christian
C
Mazzitelli
Domenico
D
Busch
Raymonde
R
Tassani-Prell
Peter
P
Lange
Ruediger
R
D000328:Adult; D000367:Age Factors; D000368:Aged; D004812:Epidemiologic Methods; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D012086:Reoperation / Q000379:methods; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*; D014264:Tricuspid Valve Stenosis / Q000601:surgery*