Results of triple valve replacement: perioperative mortality and long term results

Between 1970 and 1984, 37 patients underwent simultaneous triple valve replacement by the same surgeon, all for rheumatic valve disease. Björk-prosthesis were used for aortic, Starr, Björk or St. Jude for mitral and bioprosthesis for tricuspid replacements. The median follow-up was 68 months (range, 2 months to 9.6 years). Two patients died in the first postoperative month (5.4%). Most late deaths were of cardiac origin. 85% of all deaths were in Functional Class IV. Five and ten year actuarial survival rate was 75% and 58% for the entire group. Twenty three long-term survivors were followed; all were improved for at least one Functional Class (p = 0.001). Moderate but significant (p = 0.05) cardiothoracic ratio regression was observed. Seven patients had postoperative non lethal complications. In summary, when necessary, triple valve replacement carried an excellent symptomatic improvement. Surgical intervention before patients reach Functional Class IV is preferable. The use of bioprosthesis in tricuspid position is suggested.