Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: Analysis of outcome in 34 patients

Background and aims of the study: Patients with symptoms of right heart fai lure due to severe tricuspid regurgitation following a prior operation on l eft heart valves present a difficult problem. The outcome of tricuspid surg ery in this setting is not well defined. We describe a single-center experi ence of isolated tricuspid valve surgery after prior left heart valve surge ry, and analyze potential risk factors for a poor outcome, Methods: Thirty-four patients who underwent isolated tricuspid valve operat ion for severe tricuspid regurgitation following prior valvular surgery for left-sided valve disease between 1980 and 1997 were identified. Charts wer e reviewed for clinical, echocardiographic, catheterization and surgical da ta. Follow up of survivors was conducted by telephone to ascertain function al status. Results: Three patients died in hospital (early mortality rate, 8.8%). At a follow up of 71 +/- 39 months, 13 patients were alive and 21 reached an en d-point (three cardiac reoperations, 18 deaths). Event-free actuarial survi val at five years was 41.6 +/- 9.2%. Patients who were alive at follow up h ad a mean NYHA functional class of 2.1 +/- 0.6 compared with 3.4 +/- 0.5 pr eoperatively; 85% of survivors were symptomatically improved. Predictors of poor outcome were: increased age at the time of tricuspid surgery (p = 0.0 007) and higher number of prior cardiac operations (one versus two or three , p-value 0.01, relative risk 3.4). Pulmonary artery systolic pressure, lef t ventricular ejection fraction, right ventricular function and size, annul us diameter, tricuspid valve pathology, and valve replacement versus repair were not predictive of outcome. Conclusions: Isolated tricuspid valve surgery for severe tricuspid regurgit ation following prior surgery for left-sided heart valve disease can be per formed with acceptable early mortality, There remains a high late mortality that is predicted only by age and the number of previous cardiac operation s. However, in this selected group of severely symptomatic patients, signif icant improvement in symptoms are achieved in the survivors.