Triple-valve replacement: an analysis of eight years' experience

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease

Background:

• Combined aortic, mitral, and tricuspid valve replacement is a complex procedure.
• Outcomes and survival rates for this extensive surgery require thorough evaluation.

Purpose of the Study:

• To review the experience with combined aortic, mitral, and tricuspid valve replacement.
• To identify factors influencing hospital mortality and long-term survival.
• To present current indications for tricuspid valve replacement versus repair.

Main Methods:

• Retrospective review of 38 patients undergoing combined valve replacement between 1966 and 1974.
• Analysis of hospital mortality, late deaths, and survival rates.
• Assessment of functional class improvement and factors affecting outcomes.

Main Results:

• Hospital mortality was 23.7%, significantly higher in New York Heart Association (NYHA) Class IV (40%) versus Class III (18%).
• Intraoperative myocardial injury was a key factor in hospital mortality.
• Five-year survival was 53% overall, and 62% for NYHA Class III patients.
• 76% of hospital survivors improved by at least one NYHA functional class.

Conclusions:

• Surgical intervention before patients reach NYHA Class IV status is recommended for better early and long-term results.
• Tricuspid valve replacement should be considered carefully, with specific indications outlined.
• Optimizing patient selection and surgical timing can improve outcomes in complex multi-valve surgery.