Clinical mid-term results after tricuspid valve replacement.
Tricuspid valve replacement (TVR) is associated with high mortality and morbidity. Frequently, TVR is performed in critically ill patients with high frequency of re-intervention. We analyzed our experience in TVR focusing on predicting risk factors, mid-term survival and quality of life assessed with a Short-Form 36 Health Survey (SF-36) questionnaire. Between January 1992 and May 2007, 81 consecutive patients underwent TVR (54 re-interventions, 66.7%; 46 procedures, associated with a left-sided operation, 56.8%). There were 59 females (73%) with a mean age of 59.3+/-11.6 years. The most prevalent etiology was rheumatic fever (61.7%). Pulmonary hypertension was present in 64%. Mean left ventricle ejection fraction (LVEF) was 56.6% and mean right ventricle ejection fraction (RVEF) was 48.1%. All but four patients (4.9%) received a bio-prosthesis. Hospital mortality was 9.88%. The mean follow-up was 61+/-42 months. Survival was 68% at five years. Univariate predictors of hospital mortality were atrial fibrillation (AFib) (P<0.01), associated procedures on the left heart (P=0.025) and preoperative chronic right heart failure symptoms (P<0.01). At follow-up: 10.8% of patients had a pace-maker (PM) induced rhythm; the mean SF-36 score was 51.1+/-4.8 (range 59-38). Age (P=0.015), associated procedures (P=0.024) and previous cardiovascular surgery (P=0.015) were univariate predictors of the SF-36 score. At a multivariate analysis LVEF, venous congestion and pulmonary artery pressures (PAPs) were related with a SF-36 score.
Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. gcm.vigano@virgilio.it
Giorgio
G
Viganò
Andrea
A
Guidotti
Maurizio
M
Taramasso
Andrea
A
Giacomini
Ottavio
O
Alfieri
D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011336:Probability; D011475:Prosthesis Failure; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000601:surgery; D014264:Tricuspid Valve Stenosis / Q000401:mortality / Q000601:surgery