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[Tricuspid valve replacement: long-term clinical and echocardiographic follow-up]
J M Farinas1, Y Leclerc, A M Antchouey
1Service de Chirurgie, Institut de Cardiologie de Montréal, Québec, Canada.
Insights
Long-term tricuspid valve replacement outcomes show significant operative mortality and reoperation rates, particularly in later years. While many patients experienced improved functional class, long-term survival remains a concern, with bioprosthetic valve failure necessitating reoperation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Tricuspid valve disease necessitates surgical intervention.
- Long-term outcomes of tricuspid valve replacement (TVR) are crucial for patient management.
- Understanding risk factors and survival post-TVR informs clinical practice.
Purpose of the Study:
- To retrospectively evaluate the long-term clinical and echocardiographic results of tricuspid valve replacement.
- To identify risk factors associated with operative mortality.
- To assess patient outcomes, including functional status and reoperation rates, after TVR.
Main Methods:
- Retrospective analysis of 55 patients undergoing tricuspid valve replacement between 1969 and 1993.
- Echocardiographic and clinical data were collected and analyzed.
- Patients were divided into two groups based on myocardial protection methods (1969-1980 vs. 1981-1994).
Main Results:
- Operative mortality was 23%, with higher rates in the later group (27% vs. 15%).
- Reoperations were more frequent in the later group (72% vs. 36%).
- High pulmonary pressure, bypass time, and abnormal ejection fraction were risk factors for operative mortality. Bioprosthetic valve failure led to reoperation in 4 patients after a mean of 11.5 years. Overall mortality during follow-up was 50% at 75 months post-surgery.
Conclusions:
- Tricuspid valve replacement has significant operative risks and long-term mortality.
- Bioprosthetic valve durability remains a concern, often requiring reoperation.
- Despite risks, a notable percentage of patients experience improved New York Heart Association (NYHA) class post-surgery.
Abstract:
Long term results of tricuspid valve replacement, were evaluated by echocardiographic and clinical means retrospectively on 55 patients hospitalized at the Montreal Heart Institute between 1969 and 1993. Twenty seven percent were male and 73% female. Taking into account differences in means of myocardial protection the whole population was divided in 2 groups. Group 1: 19 patients from 1969 to 1980. Group 2: 36 patients - from 1981 to 1994. Forty seven patients (85%) received a bioprosthesis and 8 (15%) a mechanical valve. Forty one (74%) had another surgical procedure and 60% (33 patients) were re-operations. Mortality at 30 days is 23% (13 patients) -15% group 1 and 27% group 2. Twenty six patients (72%) of group 2 were re-operations compared with 7 (36%) for group 1 (p = 0.026). Risk factors of operative mortality were: high systolic pulmonary pressure (0.051), bypass time (0.012) and abnormal ejection fraction (0.025). Mean time of follow up is 113.8 months completed at 95%. Six patients were re-operated; 4 for failure of bioprosthesis 11.5 years (mean) after initial surgery. Forty three percent of patients presented with an amelioration of NYHA class. 26% in class I and 50% in class II. Mean gradient across the tricuspid valve was 4.1 +/- 1 mm Hg. Twenty two over 42 patients (50%) died during follow up: 75 months after surgery.