title: Tricuspid valve replacement: an analysis of risk factors and outcomes.
abstract: BACKGROUND
  Tricuspid valve replacement (TVR) is rarely performed and is associated with a high morbidity and mortality. We report our experience with TVR and related adverse events.
  
  
  METHODS
  Between January 1996 and December 2007, 35 patients underwent TVR with mechanical (n = 33) or bioprosthetic (n = 2) valves. Twenty-nine patients underwent concomitant cardiac procedures.
  
  
  RESULTS
  All patients completed follow-up (mean 47 months). Thirty-day mortality was 20 % (n = 7). Risk factors included perioperative low arterial blood pressure ( P = 0.000), New York Heart Association (NYHA) functional class III or IV ( P = 0.001), severe pulmonary hypertension (pulmonary arterial pressure greater than 60 mmHg) ( P = 0.000), hepatic dysfunction ( P = 0.000), ascites ( P = 0.003), and reoperation ( P = 0.015). Late mortality occurred in five patients. Valve-related complications included bleeding (n = 1) and stroke (n = 1). Kaplan-Meier estimates of 1-, 5- and 10-year survival (including early mortality) and event-free survival were 77.1 %, 60 %, and 54.3 % and 91.1 %, 80.6 %, and 55.9 %, respectively. Severe pulmonary hypertension was the only predictor of late mortality ( P = 0.001). Among survivors, the mean NYHA class improved from 2.8 to 1.1 ( P = 0.000).
  
  
  CONCLUSIONS
  Although early outcome after TVR is suboptimal, long-term survival and functional improvement is satisfactory.
authors.affiliation: Department o Cardiovascular Surgery, Marmara University School of Medicine, Istanbul, Turkey. alicivelek@tnn.net
authors.forename: A
authors.initials: A
authors.lastname: Civelek
authors.forename: K
authors.initials: K
authors.lastname: Ak
authors.forename: S
authors.initials: S
authors.lastname: Akgün
authors.forename: S C
authors.initials: SC
authors.lastname: Isbir
authors.forename: S
authors.initials: S
authors.lastname: Arsan
mesh_terms: D001201:Ascites / Q000150:complications; D001705:Bioprosthesis; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008107:Liver Diseases / Q000150:complications; D008297:Male; D012086:Reoperation; D012307:Risk Factors; D014261:Tricuspid Valve