title: Surgical risk and outcome of repair versus replacement for late tricuspid regurgitation in redo operation.
abstract: BACKGROUND
  Late tricuspid regurgitation after previous cardiac operation remains controversial in terms of when to repair and who will benefit. We reviewed our surgical experiences and stratified the risk factors for death and morbidity.
  
  
  METHODS
  From September 2005 to September 2010, 77 consecutive patients (36 men [47%]) underwent redo open heart operations with the tricuspid valve (TV) procedure. Their mean age was 56±13 years (range, 27 to 83 years). TV repair was performed in 44 (57%) and TV replacement in 33 (43%): 23 received bioprostheses; 10 received mechanical prostheses.
  
  
  RESULTS
  Fourteen (18%) patients died after the operation. Risk factors of hospital death by multivariate analysis were age (>65 years), preoperative renal insufficiency (creatinine>2 mg/dL), and preoperative severe liver cirrhosis (Child classification C). Compared with the group that underwent TV repair, those who underwent TV replacement tended to have had previous TV operations (46% vs 9%; p<0.001) and preoperative Child class C liver cirrhosis (21% vs 2%; p=0.018). Although in-hospital mortality was insignificant (24% vs 14%; p=0.232), postoperative morbidities of tracheotomy, gastrointestinal bleeding, and late death were higher in the replacement group.
  
  
  CONCLUSIONS
  Patients who had previous TV operations and preoperative severe liver cirrhosis were more likely to undergo TV replacement in tricuspid reoperations. Compared with patients in the repair group, patients in the replacement group had higher morbidities and low late survival. Earlier intervention, before decompensated heart failure occurs, is warranted to improve the outcome.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
authors.forename: Shao-Wei
authors.initials: SW
authors.lastname: Chen
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Tsai
authors.forename: Feng-Chang
authors.initials: FC
authors.lastname: Tsai
authors.forename: Yin-Kai
authors.initials: YK
authors.lastname: Chao
authors.forename: Yao-Kuang
authors.initials: YK
authors.lastname: Huang
authors.forename: Jaw-Ji
authors.initials: JJ
authors.lastname: Chu
authors.forename: Pyng-Jing
authors.initials: PJ
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*