Trends and results in tricuspid valve surgery

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair and Replacement

Background:

• Tricuspid valve disease necessitates surgical intervention, with various repair and replacement techniques available.
• Outcomes of different tricuspid valve surgical approaches require ongoing evaluation to guide clinical practice.

Purpose of the Study:

• To evaluate the outcomes of different tricuspid valve surgical procedures, including conservative repairs and valve replacements.
• To compare operative mortality, long-term survival, and complication rates among various tricuspid valve interventions.

Main Methods:

• Retrospective analysis of 46 tricuspid valve operations performed over 12 years.
• Categorization of procedures into conservative repairs (valvotomy, DeVega annuloplasty, Carpentier ring) and valve replacement (mechanical, tissue).
• Comparison of operative mortality, functional class, use of cardioplegia, annuloplasty, heart block incidence, and long-term survival.

Main Results:

• Operative mortality improved with better preoperative functional class, cardioplegia use, or annuloplasty.
• Heart block incidence was significantly lower with annuloplasty (6%) compared to other methods (24%).
• Long-term survival was comparable between annuloplasty and tissue valve replacement but poorer with mechanical valve replacement. DeVega annuloplasty had a failure rate of 50%.

Conclusions:

• Carpentier ring annuloplasty is a safe and effective option for suitable tricuspid valve anatomies.
• Tissue valve replacement is preferable to mechanical valve replacement when valve replacement is necessary for the tricuspid position.
• Conservative surgical approaches, particularly Carpentier ring annuloplasty, demonstrate favorable outcomes and should be considered when anatomically feasible.