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Eur J Cardiothorac Surg 2007;32:296-300. doi:10.1016/j.ejcts.2007.05.003
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

What to expect after tricuspid valve replacement? Long-term results

Department of Cardiovascular Surgery, Yuksek Ihtisas Hospital of Turkey, Ankara, Turkey

Received 14 March 2007; received in revised form 13 April 2007; accepted 7 May 2007.

^_* Corresponding author. Address: N. Tandogan cad. 5/6 Kavaklidere, 06540 Ankara, Turkey. Tel.: +90 312 426 7574; fax: +90 312 426 6181. (Email: kvural{at}tr.net).

Objective: Current knowledge in long-term results of tricuspid valve replacement is limited. Present study reviews our experience from a consecutive series. Methods: Forty-two patients (16 male, 26 female; mean age: 33 ± 15) underwent tricuspid valve replacement between March 1987 and December 2004. The etiology was rheumatic in 64%, Ebstein's anomaly in 31%, and endocarditis in 5%. Nineteen patients were in New York Heart Association (NYHA) Class III functional capacity (45%), and 13 in class IV (31%). Twenty patients (48%) underwent isolated tricuspid valve replacement. The remaining underwent combined (mitral and/or aortic) valve replacements. Tricuspid replacement device was mechanical in 31% and bioimplant in 69%. Results: Hospital mortality was 26%. Rheumatic etiology, reoperation and elevated pulmonary artery pressure were associated with higher early mortality. The patients with decreased functional capacity (NYHA Class III/IV), congestive symptoms and rheumatic origin were more prone to low cardiac output development. The Kaplan–Meier survivals were 37% at 10 years and 30% at 15 years. The 10-year event-free survival was 31%. Elevated pulmonary artery pressure and rheumatic etiology unfavorably affected the long-term results. The average functional capacity in survivors improved significantly after operation. Conclusions: Any tricuspid disease not amenable to repair thus necessitating replacement is an unfortunate situation since both the short and long-term results of valve replacement are suboptimal in regard to those of left-sided valve replacements, probably due to different structural and geometrical characteristics of right ventricle and the low-pressure venous system hemodynamics. Etiology, clinical presentation and pulmonary vascular hemodynamics are major determinants of the outcome.

Key Words: Tricuspid valve replacement • Heart valve • Endocarditis • Rheumatic

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