title: Isolated tricuspid valve surgery: predictors of adverse outcome and survival.
abstract: BACKGROUND
  Isolated tricuspid valve surgery is a rare operation, for which outcomes are not well defined. We describe a single-centre experience with isolated tricuspid surgery, and an analysis of risk factors for adverse outcome and predictors of survival.
  
  
  METHODS
  Retrospective analysis of 56 consecutive adult patients undergoing isolated tricuspid valve surgery between November 1998 and November 2010 was performed.
  
  
  RESULTS
  Eight patients died in hospital (early mortality 14.2%). In comparison with tricuspid repair patients, tricuspid replacement patients required more intraoperative red cell blood transfusion (RBC>1 unit: p=0.033), platelet transfusion (p=0.051), and more postoperative ventilator support (p=0.023). Predictors of early (in hospital) mortality include advanced age (p=0.019) higher euroSCORE (p<0.001), transfusion of intraoperative red blood cells (p=0.005), and cryoprecipitate (p=0.014). Twenty-five patients (44.6%) reached the end-point of death. There was no statistical difference in early and late survival rates between repair and replacement groups.
  
  
  CONCLUSIONS
  Patients with isolated tricuspid valve surgery continue to be a high-risk group in cardiac surgery with unacceptable operative mortality and limited survival. There were no statistical differences in early and late outcomes between the isolated tricuspid valve repair versus replacement surgery. Timely referral to surgery before the onset of class 3 heart failure, malnutrition, renal dysfunction and age>60 years is recommended.
authors.affiliation: Anesthesiology and Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, United States. jraikhelkar@yahoo.com
authors.forename: Jayashree
authors.initials: J
authors.lastname: Raikhelkar
authors.forename: Hung-Mo
authors.initials: HM
authors.lastname: Lin
authors.forename: David
authors.initials: D
authors.lastname: Neckman
authors.forename: Anoushka
authors.initials: A
authors.lastname: Afonso
authors.forename: Corey
authors.initials: C
authors.lastname: Scurlock
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017707:Erythrocyte Transfusion; D005169:Factor VIII / Q000008:administration & dosage; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage; D006349:Heart Valve Diseases / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D016016:Proportional Hazards Models; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014261:Tricuspid Valve / Q000601:surgery*; D055815:Young Adult
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen