Repair of rheumatic tricuspid valve disease: predictors of very long-term mortality and reoperation.
BACKGROUND
We examined predictors of reoperation and late mortality in patients undergoing tricuspid valve repair for rheumatic disease.


METHODS
Between 1997 and 2007, 299 consecutive patients (mean age 50.8 + or - 13.7 years) underwent surgical repair of the tricuspid valve for multivalvular organic rheumatic disease. A total of 184 patients was found to have mitral and tricuspid valve disease, 108 triple valve disease, 5 isolated tricuspid lesion, and 2 aortic and tricuspid valve disease. Prosthetic ring annuloplasty was performed in 78 patients, commissurotomy and ring annuloplasty in 82, isolated commissurotomy in 10, suture annuloplasty in 105, and commissurotomy and suture annuloplasty in 24.


RESULTS
Thirty-day mortality was 7.4%. Previous valve surgery and reoperation for bleeding were risk factors for early death. Late mortality was 51.2%, in the majority of patients due to cardiac causes. There was a median follow-up of 16.4 years (range, 6 months to 34 years) and cumulative follow-up of 5,432 patients per year (96.7% complete). Age, New York Heart Association functional class IV and postclamping time were predictive factors for late mortality. At 25 years, the Kaplan-Meier survival was 26.6% + or - 4.2%. A total of 106 patients required valve reoperation. Age older than 40 years was a protective factor for reoperation. At 25 years, Kaplan-Meier freedom from reoperation was 35.0% + or - 5.3%.


CONCLUSIONS
Repair of the tricuspid valve in patients with rheumatic valve disease can be performed with acceptable early results, but progression of rheumatic disease is associated with a high incidence of valve dysfunction and mortality in the long term.
Sarralde
J Aurelio
JA
Department of Cardiovascular Surgery, CIBER Epidemiología y Salud Pública, Hospital Universitario Valdecilla, Universidad de Cantabria, Santander, Spain.
Bernal
José M
JM
Llorca
Javier
J
Pontón
Alejandro
A
Diez-Solorzano
Lorena
L
Giménez-Rico
Juan R
JR
Revuelta
José M
JM
D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000401:mortality* / Q000601:surgery*; D013997:Time Factors; D014261:Tricuspid Valve