Outcomes of Isolated Tricuspid Valve Surgery

Abstract

Background: Isolated tricuspid valve surgery is a rarely performed procedure and traditionally is associated with a bad prognosis, although its clinical outcomes still are little known. The aim of this study was to assess the short- and long-term clinical outcomes obtained at our center after isolated tricuspid valve surgery as treatment for severe tricuspid regurgitation. Methods: This retrospective study included 71 consecutive patients with severe tricuspid regurgitation who underwent isolated tricuspid valve surgery between December 1996 and December 2017. Perioperative and long-term mortality, tricuspid valve reoperation, and functional class were analyzed after follow up. Results: Regarding surgery, 7% of patients received a De Vega annuloplasty, 14.1% an annuloplasty ring, 11.3% a mechanical prosthesis, and 67.6% a biological prosthesis. Perioperative mortality was 12.7% and no variable was shown to be predictive of this event. After a median follow up of 45.5 months, long-term mortality was 36.6%, and the multivariate analysis identified atrial fibrillation as the only predictor (Hazard Ratio 3.014, 95% confidence interval 1.06-8.566; P = 0.038). At the end of follow up, 63.6% of survivors had functional class I. Conclusions: Isolated tricuspid valve surgery was infrequent in our center. Perioperative mortality was high, as was long-term mortality. However, a high percentage of survivors were barely symptomatic after follow up.

Outcomes of minimally invasive isolated tricuspid valve repair and replacement through right mini-thoracotomy

“… 10 , 11 Other studies have reported in-hospital mortality rates within a varying range of 10 to 13%. 12 , 13 , 14 The individualized perioperative care provided by a single surgeon in our Mini-TVS experience may have contributed to the positive surgical outcomes in this cohort. Furthermore, our previous ITV national outcomes study showed no difference in in-hospital mortality between TVR and TVre.…”

Case Report: Tricuspid Annuloplasty for Right-Sided Congestive Heart Failure Secondary to Pulmonary Hypertension in a Dog

“…However, use of this method for tricuspid valve surgery in dogs has not yet been reported. In human medicine, De Vega annuloplasty is useful for correcting functional TR with low longterm recurrence rates (16,(19)(20)(21)(22). In human patients, the target annulus diameter is decided using an index calculated according to body surface area.…”

Transcatheter Tricuspid Valve-in-Valve Procedure—An Illustrative Case Report and Review

“…The indication and therapeutic approach were discussed by the multidisciplinary heart team. Despite a moderate STS Score = 5.17% and EuroScore II = 5.24%, a conventional open surgery was ruled out, considering the poor risk-benefit ratio expected as largely reported in the literature of isolated tricuspid reoperations [6][7][8]. TTVR was the therapy of choice for her.…”

“…Because of this, it has been relatively neglected both in the literature and clinically as compared to the primary left-sided diseases [3]. Furthermore, the rarity of TV surgical management, and its high post-operative mortality and morbidity [7][8][9], in addition to the lack of evidence proving the superiority of surgical treatment over medical therapy in severe TR [10], has led it to be called the "forgotten valve" for a long time [3,11].…”

“…Nonetheless, despite the renewed interest in earlier surgery for patients with severe isolated TR before the onset of severe RV dysfunction or end-organ damage and recent improvement in mid to long-term results [19][20][21], isolated TV surgery remains rare and to this day continues to be associated with the highest surgical risk among all valve procedures and high operative mortality rates, especially in reoperations [7][8][9]. In this framework, catheter-based therapies for patients with severe isolated TR has become an area of rapid evolution and growing interest [22], furthermore following the trend of valvular heart disease towards less invasive surgical and percutaneous therapies.…”