Clinical mid-term results after tricuspid valve replacement☆

Abstract

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.

Tricuspid valve replacement with mechanical prostheses: Short and long-term outcomes

“…In our cohort, the operative mortality was 19.4%, similar to other previously published studies, which shows mortality rates between 5 and 25%, with a progressive decline in recent years . Our mortality results are in accordance with those reported in the literature, which are usually in the range of 25‐40%, with the only exception of Park et al who reported a relatively low mid‐term mortality. Rodríguez‐Capitán et al reported a perioperative mortality of 18.5% for tricuspid valve surgery, with a mortality of 29.9% at 41 months follow‐up.…”

“…Previous publications addressing the impact of TVR have not been specifically focused on mechanical valves. In these studies, operative mortality has been reported in the range of 5‐25%, whereas long‐term mortality is usually in the range of 25‐40% . In the present study, we analyzed mortality and morbidity of patients who underwent mechanical TVR.…”

Transcatheter Therapies for the Treatment of Valvular and Paravalvular Regurgitation in Acquired and Congenital Valvular Heart Disease

“…Additionally, patients who develop progressive TR late after left-sided valve surgery represent a particular challenge (14). In this subgroup, despite medical management, surgical correction is associated with a higher risk of morbidity and mortality as a result of the presence of variable degrees of RV dysfunction, pulmonary vascular disease, and right heart failure.…”

De Vega annuloplasty versus ring annuloplasty for repair of functional tricuspid regurgitation

“…A prospective randomized study of 159 patients conducted by Rivera et al comparing De Vega suture to ring anuloplasty demonstrated higher recurrence of moderate and sever TR in the De Vega group. 25,26 Similarly, a study of 790 patients by McCarthy et al reported an earlier recurrence and progressive increase of moderate and severe TR after De Vega repair compared with ring annuloplasty. 26,27 The retrospective nature of the study and the single centre design are the major limitations…”