title: Is tricuspid valve replacement a catastrophic operation?
abstract: OBJECTIVE
  Tricuspid valve replacement (TVR) has a high postoperative mortality, despite recent advances in perioperative care. We report the results of our experience in TVR with an emphasis on early mortality and morbidity and long-term follow-up.
  
  
  METHODS
  Between October 1994 and August 2007, 80 consecutive TVRs were performed in 78 patients. The mean age was 48+/-14 (range: 20-70) years. The underlying disease of the patients was classified as rheumatic (n=54), congenital (n=12), endocarditis (n=10) or degenerative (n=4). Previous cardiac surgery had been performed in 40 patients (50%). Isolated TVR was performed in 24 patients (30%).
  
  
  RESULTS
  Hospital mortality occurred in one patient (1.4%). Postoperative morbidities included intra-aortic balloon pump (n=5), bleeding re-operation (n=4), delayed sternal closure (n=3), acute renal failure (n=3), subdural haematoma (n=3), extracorporeal membrane oxygenation (n=1), mediastinitis (n=1) and pacemaker insertion (n=4). In 42 patients, ventilator support was needed for more than 72 h. Based on multivariate analysis, age (p<0.001) and the cardiopulmonary time (p=0.004) were the identified risk factors. Follow-up was completed in all patients with a mean duration of 56+/-37 (range: 0-158) months. During the follow-up period, there were seven deaths (8.8%), including five cardiac deaths. The 5- and 8-year survival rates were 95+/-3% and 79+/-9% and event-free survival rates were 76+/-6% and 61+/-9%, respectively. Based on multivariate analysis, the only identified predictors of late deaths was a postoperative low cardiac output (p=0.024).
  
  
  CONCLUSIONS
  TVR can be performed and low operative mortality can be achieved thorough optimal perioperative management in the current era.
authors: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Republic of Korea.
authors: Kiick
authors: K
authors: Sung
authors: Pyo Won
authors: PW
authors: Park
authors: Kay-Hyun
authors: KH
authors: Park
authors: Tae-Gook
authors: TG
authors: Jun
authors: Young Tak
authors: YT
authors: Lee
authors: Ji-Hyuk
authors: JH
authors: Yang
authors: Wook Sung
authors: WS
authors: Kim
authors: Joomin
authors: J
authors: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D004812:Epidemiologic Methods; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D055815:Young Adult