Original article
Cardiovascular
Long-Term Outcomes of Tricuspid Valve Replacement in the Current Era

https://doi.org/10.1016/j.athoracsur.2004.12.019Get rights and content

Background

Regardless of the indication, tricuspid valve replacement (TVR) has historically been associated with high mortality and morbidity. We report the results of our experience in a high-risk patient population with an emphasis on operative mortality, long-term survival, and valve related events according to the type of prosthesis.

Methods

Between 1985 and 1999 TVR was performed in 81 patients (isolated n = 25, combined with valve surgery n = 44, combined with CABG or other n = 12). The mean age was 61 years old (range 19–83 years old). Risk factors included New York Heart Association functional class III/IV (n = 73, 90%), reoperation (n = 58, 72%), urgent/emergent indication (n = 62, 76%), and hepatic dysfunction (n = 13, 16%). Mean pulmonary artery pressure was 34 mmHg. Etiology of tricuspid regurgitation was classified as functional (n = 18, 22%) or organic (n = 52, 64%), or failed previous tricuspid valve surgery (n = 11, 14%).

Results

Tricuspid valve replacement was performed with either a bioprosthetic (n = 34, 42%) or mechanical valve (n = 47, 58%). The overall operative mortality was 22% (n = 18). Risk factors for mortality included urgent/emergent status, age greater than 50 years old, functional etiology, and elevated pulmonary artery pressure. Of the 60 survivors, 26 (43%) died during follow up. After univariate analysis, organic etiology was the only predictor of late death (p = 0.01). Kaplan-Meier survival at 2.5, 5, and 10 years was 80%, 60%, and 45% for bioprosthetic, and 84%, 69%, and 59% for mechanical valves, respectively.

Conclusions

Patients requiring TVR are typically high-risk with a high-percentage of reoperations, concomitant cardiac procedures, and end-stage functional class. Operative and overall mortality remains high. Heart failure was the predominant cause of early and late deaths, emphasizing importance of timely referral before the development of end-stage cardiac impairment.

Section snippets

Material and Methods

We retrospectively reviewed data on 81 consecutive patients who underwent TVR at the Brigham and Women’s Hospital over a 15-year period from January 1985 to December 1999. Data were extracted from the hospital’s computerized database with additional information obtained through retrospective chart review. We included all patients who underwent TVR either as an isolated procedure or in combination with other procedures. We included patients based on the completed surgical technique rather than

Operative and In-Hospital Mortality and Morbidity

The overall in-hospital mortality was 22% (n = 18). There was a tendency toward higher early mortality with bioprosthetic valves (n = 11, 32%) compared with mechanical valves (n = 7, 15%) (p = 0.06), but this difference did not persist beyond the first year. Twenty-four patients (29%) suffered from postoperative low cardiac output syndrome and 15 (18%) returned to the operating room for excessive postoperative bleeding. There were 2 patients (2%) who developed deep sternal wound infections and

Comment

In this series of patients undergoing tricuspid valve replacement in the current era, we have found that the procedure still has a very high immediate perioperative morbidity and mortality rate, and that there is a constant risk of death (up to 3% per year) in the medium-term to long-term outcome. In common with other published series [1, 2, 3, 4, 5], a majority of our patients had undergone previous cardiac surgery and were in New York Heart Association functional class III or IV. Although the

Requirements for Recertification/Maintenance of Certification in 2006

Diplomates of the American Board of Thoracic Surgery who plan to participate in the Recertification/Maintenance of Certification process in 2006 must hold an active medical license and must hold clinical privileges in thoracic surgery. In addition, a valid certificate is an absolute requirement for entrance into the recertification/maintenance of certification process. if your certificate has expired, the only pathway for renewal of a certificate is to take and pass the Part I (written) and the

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