Tricuspid valve replacement with mechanical prostheses: long-term results.
OBJECTIVE
Historically, tricuspid valve replacement (TVR) has been associated with high mortality and morbidity, and current knowledge in the long-term outcome of TVR is limited. The study aim was to review the authors' experience from a consecutive series of patients.


METHODS
Between January 1990 and December 2005, a total of 43 patients (seven males, 36 females; mean age 52 +/- 14 years) underwent TVR. The etiology was rheumatic in 33 patients (77%) and degenerative disease in 10 (22%). Thirty-six patients (84%) were in NYHA class III or IV. Thirty-four patients (79%) underwent redo procedures; all patients underwent TVR with a mechanical prosthesis.


RESULTS
The overall operative mortality was 16% (n = 7). Of the 36 survivors, nine (25%) died during follow up. The Kaplan-Meier survival at 2.5, 5, and 10 years was 78%, 70%, and 58%, respectively. Five patients (14%) underwent reoperation during follow up (three for tricuspid valve thrombosis) and all five survived the reoperation. Freedom from reoperation at five and 10 years was 90% and 74%, respectively. On permutation test analysis, older age, liver congestion and redo surgery were found to be the major determinants of long-term mortality.


CONCLUSIONS
TVR carries a higher short- and long-term mortality when compared to left-heart valve surgery. A timely referral before the development of end-stage cardiac impairment might determine a further improvement in outcome.
Garatti
Andrea
A
Department of Cardiovascular Disease, 'E. Malan', Cardiac Surgery Unit, Policlinico S. Donato Hospital, San Donato Milanese, Milan, Italy. agaratti@tiscali.it
Canziani
Alberto
A
Mossuto
Eugenio
E
Gagliardotto
Piervincenzo
P
Innocente
Francesco
F
Corain
Livio
L
Frigiola
Alessandro
A
Menicanti
Lorenzo
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D015996:Survival Rate; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000601:surgery; D055815:Young Adult