Midterm Follow-up of Patients Following Tricuspid Valve Replacement

Between January 1980 and January 1996, 620 patients with valvular heart diseases underwent several types of tricuspid valve procedures (De Vega annuloplasty: 483, Kay annuloplasty: 8, implantation of Duran ring: 15, implantation of Puig-Massana ring: 18) associated valvular heart surgery. Of these cases 96 patients (15.5%) received 100 prosthetic tricuspid. valves (96 mechanical, 31 biologic). Sixty-five mitral, 21 aortic concomitant valve replacements were also made. Forty-three cases (45%) had previous heart surgery including closed mitral commissurotomy (12), mitral valve replacement ( 18), mitral and aortic valve replacement (6), repair of ventricular septal defect (VSD: 2), repair of atrial septal defect (ASD: 2), total correction of tetralogy of Fallot ( 1 ), and repair of Ebstein's anomaly (2). Mean age was 35 ± 1 1 years (range 14-56 years), and 20% of the patients were males. In all cases, an annuloplastic technique was first attempted for the tricuspid valve, but when this was not successful, valve replacement was performed. Nearly in all patients, except congenital cases such as repair of an ASD, VSD or Ebstein's anomaly, tricuspid procedures were accomplished under cardiopulmonary bypass with the beating heart, without aortic clamping. Preoperative hemodynamic measurements of the patients were as follows: PAP 54±21, PCWP 23±8, CVP 16±5 mmHg. Atrial fibrillation was present in 95% of the cases. Early (30 days or hospital) mortality was 26%. Eighty-four percent of cases were followed-up from two months to 121 months (mean 45±22 months). Four (4%) of the patients required reoperation for tricuspid valve dysfunction (thrombosis 2, degeneration of the bioprosthesis 1, paravalvular leakage 1). During the follow-up period there were six (8.5 %) Iate deaths. survival rates for 12, 36, and 48 months were 66%, 52%, and 30%, respectively, the median survival being 42 months. Sixty- seven percent of the survivors were in NYHA functional class I and II. We conclude that, in cases in which repairing is not possible nor successful, tricuspid valve replaccment should be performed , keeping in mind that the early mortality rate is high, however, the mid-term survival is barely in acceptable limits.