Tricuspid valve replacement in rheumatic disease: preoperative predictors of hospital mortality

The study analyzes the possible predictive power of different clinical and hemodynamic parameters with regard to hospital mortality after the first tricuspid valve replacement.

A retrospective study of 62 consecutive patients undergoing tricuspid valve replacement from 1974 to 1994 (7.2% of all tricuspid surgery performed at our institution in this period) was completed. Hospital mortality was 37%. Twenty-three patients died in hospital after the first tricuspid valve replacement (group I) and 39 patients (group II) survived this procedure. Tricuspid insufficiency was organic in 87% of group I and 84.6% of group II.

The parameters showing significant differences between the two groups were NYHA class IV (p = 0.05), severe congestive heart failure (p = 0.02), mean right atrial pressure (p = 0.05), pulmonary arterial resistance (p = 0.006) and mean pulmonary arterial pressure (p = 0.0001). Cardiopulmonary bypass time (p = 0.005) and aortic cross-clamp time (p = 0.05) were longer in group I. Multiple regression analysis showed that the variables with greatest predictive power for hospital death were preoperative functional class, congestive heart failure and mean pulmonary artery pressure. The model gave a p < 0.001, with r = 0.58.

The high hospital mortality rate after tricuspid valve replacement seems to be related to clinical functional class, severe congestive heart failure, and to chronic hemodynamic changes in the right atrium and pulmonary circulation.