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Tricuspid reoperation after left-sided rheumatic valve operations
Dong Seop Jeong1, Pyo Won Park, Tom Philip Mwambu
1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
The Annals of Thoracic Surgery
|April 30, 2013
Summary
Tricuspid valve procedures in rheumatic patients after left-sided operations have low risk and good outcomes. Early intervention is recommended before anemia or left ventricular dysfunction develops to improve results.
Area of Science:
- Cardiovascular Surgery
- Rheumatic Heart Disease Management
Background:
- Management of late tricuspid regurgitation post-left-sided valve surgery in rheumatic patients is debated.
- This study evaluates outcomes of tricuspid valve procedures in this specific patient cohort.
Purpose of the Study:
- To analyze clinical and echocardiographic outcomes of tricuspid valve replacement versus repair in rheumatic patients following prior left-sided valve operations.
- To identify predictors of adverse events and late tricuspid regurgitation.
Main Methods:
- 106 rheumatic patients with prior left-sided valve operations underwent tricuspid valve procedures (53 replacements, 53 repairs).
- Follow-up was 97% complete with a mean of 62 months.
- Clinical and echocardiographic data were analyzed.
Main Results:
- Early mortality was low at 1.9%.
- No significant difference in 10-year cumulative survival between tricuspid valve replacement (63.1%) and repair (80.7%).
- Old age, anemia, and low left ventricular ejection fraction (<0.4) predicted major adverse cardiac events. Higher aortic transprosthetic mean pressure gradient predicted late tricuspid regurgitation after repair.
Conclusions:
- Tricuspid valve procedures in this population are low-risk with favorable outcomes.
- Early surgery is advised before significant comorbidities like anemia or left ventricular dysfunction arise.
- Maintaining a lower aortic transprosthetic mean pressure gradient may mitigate late tricuspid regurgitation progression.
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