Redo tricuspid valve operation in patients with 1^st-generation mitral prostheses

Background In patients with remarkably enlarged cardiac chambers and history of implantation of older types of mitral valve prosthesis, the considerations for reoperative tricuspid valve surgery are not limited to the risks of sternal reentry but also include the dilemma of whether to carry out prophylactic replacement of the normal functioning but outdated prosthesis or leave it in situ. Methods We reviewed our surgical strategy and postoperative 5-year follow-up findings in two patients who underwent redo tricuspid surgery 3 to 4 decades after mechanical mitral valve replacement. Both patients presented with significant symptoms of progressive right heart failure due to severe tricuspid regurgitation, despite optimal medical therapy. Results We found the beating-heart approach to be an effective and safe method for redo tricuspid surgery. Both first-generation mitral mechanical prostheses were not replaced and have remained well functional upon the patients' postoperative 5-year follow-up, respectively. Conclusion For patients with normal functioning first-generation mechanical mitral prostheses, whether to prophylactically replace the prosthesis should be based on an individualized risk-benefit analysis.