Clinical outcome after isolated tricuspid valve replacement: 20-year experience

OBJECTIVE: To examine the early and late results of isolated tricuspid valv e replacement (TVR). DESIGN AND SETTING: All isolated TVRs performed at the Montreal Heart Insti tute, Montreal, Quebec between January 1978 and January 1998 were retrospec tively reviewed. Follow-up data on patients were obtained through the valve clinic. PARTICIPANTS: From a total of 79 TVR and 375 tricuspid annuloplasties perfo rmed during the study period, 29 patients who underwent 32 isolated TVRs (s ix mechanical valves and 26 bioprostheses) were included. Patient age range d from 25 to 70 years (mean 48), and 62% were female. Twenty-seven patients (84%) were in New York Heart Association (NYHA) functional classes III and IV. Previous valve surgery had been performed in 22 patients (69%) among w hom nine had undergone TVR. RESULTS: Postoperatively, a permanent pacemaker was implanted in nine patie nts (28%), and reoperation because of bleeding was required in two patients . Mean follow-up was 67.7 months (93% complete). Serial echocardiography sh owed prosthesis dysfunction in three patients, requiring two valve re-repla cements at 12.8 and 7.7 years after initial surgery. All patients, except t hree, showed an improvement of their NYHA class. Six patients (19%) died in hospital and seven patients died during late follow-up at a mean of 38.1 m onths after surgery, including one valve-related death (mechanical valve th rombosis). The actuarial survival rate of all patients was 63% after five y ears and 47% after 10 years. CONCLUSION: Isolated TVR remaines a high risk procedure. Most survivors, ho wever, should expect a better quality of life by the improvement in their N YHA class.