Abstract 3688: New Insights on the Forgotten Valve: A Thirty-year Experience With Isolated Tricuspid Valve Surgery
INTRODUCTION: Isolated tricuspid valve (TV) surgery is infrequently performed and few data regarding its outcomes is available. The aim of this study is to analyze risk factors for TV disease recurrence, adverse events, and death after isolated TV surgery, and to compare TV replacement and repair.
HYPOTHESIS: The hypothesis is that TV replacement is more effective in correcting TV regurgitation in the long-term.
METHODS: A retrospective analysis of prospectively collected data of consecutive patients who underwent isolated TV surgery at the Montreal Heart Institute between 1977 and 2008 was conducted.
RESULTS: Among 942 TV surgeries performed, 136 were isolated TV surgeries (73 repairs, 63 replacements). Mean follow-up for the survivors was 4.1±4.7 years (494 patient-years). Mean age in the respective Replacement and Repair groups were 51±14 and 58±13 years (p<0.01). It was a reoperation for 56% of the patients (Replacement: 81%; Repair: 35%; p<0.01). In these respective groups, peripheral oedema was present in 74% and 55% of the patients (p=0.048), and TV disease was functional in 13% and 62% of the patients (p<0.01). The 9% hospital mortality was similar in both groups (p=0.4). At discharge, moderate TV regurgitation was present in 29% of the patients in the Repair group and in 12% of the patients in the Replacement group (p=0.06). At follow-up, compared to the Repair group, the patients of the Replacement group used more loop diuretics (median daily use: 40 and 160 mg, respectively; p<0.01), and were more likely to undergo a reoperation on the TV (3% and 14%, respectively; p=0.05). TV repair was an independent risk factor for severe TV regurgitation at follow-up (HR=7.5; p=0.04). Freedom from moderate TV regurgitation at 2 and 5 years in the Repair group was respectively of 77±7%, and 65±10%, while it was 92±5%, and 63±9% in the Replacement group (p=0.10). Survival at 1, 2 and 5 years in the Repair group was respectively 87±4%, 78±6%, and 70±7%, and it was 76±6%, 68±6%, and 60±7% in the Replacement group (p=0.20).
CONCLUSION: In conclusion, isolated TV surgery can be performed with an acceptable surgical risk, and TV repair (versus replacement) is a risk factor for severe regurgitation at follow-up, but it does not translate into a worse clinical outcome.