title: Surgery for rheumatic tricuspid valve disease: a 30-year experience.
abstract: OBJECTIVE
  This study was undertaken to assess factors influencing short- and long-term outcomes of surgery for rheumatic disease of the tricuspid valve.
  
  
  METHODS
  Between 1974 and 2005, a total of 328 consecutive patients (mean age 51.3 +/- 13.6 years) underwent tricuspid valve surgery for rheumatic disease. There were 12 cases of isolated tricuspid lesion, 199 of triple-valve disease, 114 of tricuspid and mitral valve disease, and 3 of aortic and tricuspid valve disease. Most patients (72%) had predominantly tricuspid regurgitation. Tricuspid valve prosthetic replacement was performed in 31 cases and valve repair in 297.
  
  
  RESULTS
  In-hospital mortality was 7.6%. Late mortality was 52.1%, whereas the expected mortality of the Spanish population of the same age was 24.2%. Predictors of in-hospital mortality were male sex, isolated tricuspid lesion, moderate aortic insufficiency, postclamping time, and tricuspid valve replacement. Mean follow-up was 8.7 years (range 1-31 years). Follow-up was 98.9% complete. Predictors of late mortality were age, New York Heart Association functional class IV, postclamping time, and mitral valve replacement. In total, 114 patients required valve reoperation, but only 4 (3.5%) for isolated tricuspid valve dysfunction. At 30 years, actuarial survival was 12.1% +/- 4.4%, actuarial freedom from reoperation was 27.5% +/- 5.8%, and actuarial freedom from valve-related complications was 2.0% +/- 1.3%.
  
  
  CONCLUSIONS
  Organic tricuspid valve disease associated with rheumatic mitral or aortic lesions increases hospital and late mortality, but valve repair compared favorably with valve replacement. Long-term results may be considered acceptable for otherwise incurable valve disease.
authors.affiliation: Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, Universidad de Cantabria, Santander, Spain. bernal@humv.es
authors.forename: José M
authors.initials: JM
authors.lastname: Bernal
authors.forename: Alejandro
authors.initials: A
authors.lastname: Pontón
authors.forename: Begoña
authors.initials: B
authors.lastname: Diaz
authors.forename: Javier
authors.initials: J
authors.lastname: Llorca
authors.forename: Iván
authors.initials: I
authors.lastname: García
authors.forename: Aurelio
authors.initials: A
authors.lastname: Sarralde
authors.forename: Carmen
authors.initials: C
authors.lastname: Diago
authors.forename: José M
authors.initials: JM
authors.lastname: Revuelta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000601:surgery*; D014261:Tricuspid Valve / Q000601:surgery*