Tricuspid valve replacement subsequent to previous open heart surgery

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair and Replacement

Background:

• Tricuspid valve replacement (TVR) is uncommon in patients without prior open-heart surgery due to earlier interventions on mitral and/or aortic valves.
• This study focuses on TVR in patients who have already undergone previous open-heart surgery.

Purpose of the Study:

• To report the short and medium-term outcomes of bioprosthetic tricuspid valve replacement (TVR) in patients with a history of previous open-heart surgery.
• To assess the risks and benefits associated with this high-risk procedure.

Main Methods:

• A consecutive series of 14 patients underwent bioprosthetic TVR between December 1985 and February 1993.
• All patients had at least one prior open-heart surgery; many were reoperations (first or second time).
• Patients were assessed preoperatively, and outcomes including mortality, reoperation, and functional status were tracked.

Main Results:

• Hospital mortality was high at 50% (7/14), with a higher incidence in patients with severe preoperative symptoms (NYHA class III/IV) and those undergoing second reoperations.
• No intraoperative deaths or immediate reoperations for bleeding/pacing occurred.
• Among discharged survivors (mean follow-up 46 months), 57% showed improved NYHA class, and all reported reduced peripheral edema. No valve-related complications were observed in survivors.

Conclusions:

• Tricuspid valve replacement in patients with prior cardiac surgery is a high-risk procedure with significant hospital mortality.
• Despite the risks, survivors may experience substantial clinical benefits, including improved functional capacity and reduced peripheral edema.