Tricuspid Valve Replacement: An Analysis of Risk Factors and Outcomes

Abstract

Background: Tricuspid valve replacement (TVR) is rarely performed and is associated with a high morbidity and mortality. We report our experience with TVR and related adverse events. Methods: Between January 1996 and December 2007, 35 patients underwent TVR with mechanical (n = 33) or bioprosthetic (n = 2) valves. Twenty-nine patients underwent concomitant cardiac procedures. Results: All patients completed follow-up (mean 47 months). Thirty-day mortality was 20 % (n = 7). Risk factors included perioperative low arterial blood pressure (p = 0.000), New York Heart Association (NYHA) functional class III or IV (p = 0.001), severe pulmonary hypertension (pulmonary arterial pressure greater than 60 mmHg) (p = 0.000), hepatic dysfunction (p = 0.000), ascites (p = 0.003), and reoperation (p = 0.015). Late mortality occurred in five patients. Valve-related complications included bleeding (n = 1) and stroke (n = 1). Kaplan-Meier estimates of 1-, 5- and 10-year survival (including early mortality) and event-free survival were 77.1 %, 60 %, and 54.3 % and 91.1 %, 80.6 %, and 55.9 %, respectively. Severe pulmonary hypertension was the only predictor of late mortality (p = 0.001). Among survivors, the mean NYHA class improved from 2.8 to 1.1 (p = 0.000). Conclusions: Although early outcome after TVR is suboptimal, long-term survival and functional improvement is satisfactory.

Key words

heart valve surgery - cardiovascular surgery - heart disease

References

• 1 Kirklin J W, Barratt-Boyes B G. Cardiac Surgery, Tricuspid Valve Disease. 3rd edn. Philadelphia (USA); Churchill Livingstone 2003: 671-688
• 2 Van Nooten G J, Caes F, Taeymans Y. et al . Tricuspid valve replacement: postoperative and long-term results.  J Thorac Cardiovasc Surg. 1995;  110 672-679
• 3 Chang B C, Lim S H, Yi G, Hong Y S. et al . Long-term clinical results of tricuspid valve replacement.  Ann Thorac Surg. 2006;  81 1317-1323
• 4 Filsoufi F, Anyanwu A C, Salzberg S P. et al . Long-term outcomes of tricuspid valve replacement in the current era.  Ann Thorac Surg. 2005;  80 845-850
• 5 Iscan Z H, Vural K M, Bahar I. et al . What to expect after tricuspid valve replacement? Long-term results.  Eur J Cardiothorac Surg. 2007;  32 296-300
• 6 Carrier M, Hebert Y, Pelerin M. et al . Tricuspid valve replacement: an analysis of 25 years of experience at a single center.  Ann Thorac Surg. 2003;  75 47-50
• 7 Rizzoli G, Vendramin I, Nesseris G. et al . Biological or mechanical prostheses in tricuspid position? A meta-analysis of intra-institutional results.  Ann Thorac Surg. 2004;  77 1607-1614
• 8 Bonow R O, Carabello B, de Leon A C. et al . Guidelines for the management of patients with valvular heart disease. Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Management of Patients with Valvular Heart Disease).  J Heart Valve Dis. 1998;  7 672-707
• 9 McGrath L B, Gonzalez-Lavin L, Bailey B M. et al . Tricuspid valve operations in 530 patients. Twenty-five-year assessment of early and late phase events.  J Thorac Cardiovasc Surg. 1990;  99 124-133
• 10 Isbell D C, Kramer C M. Cardiovascular magnetic resonance: structure, function, perfusion, and viability.  J Nucl Cardiol. 2005;  12 324-336
• 11 King R M, Schaff H V, Danielson G K. et al . Surgery for tricuspid regurgitation late after mitral valve replacement.  Circulation. 1984;  70 193-197
• 12 Sugimoto T, Okada M, Yamashita C. et al . Surgical assessment of tricuspid valve replacement for severe tricuspid regurgitation without stenosis.  Ann Thorac Cardiovasc Surg. 1999;  5 300-303
• 13 Iscan Z H, Vural K M, Bahar I. et al . What to expect after tricuspid valve replacement? Long-term results.  Eur J Cardiothorac Surg. 2007;  32 296-300