Isolated tricuspid valve replacement: Long-term results

The purpose of this study was to examine the early and late results in 29 p atients who underwent 32 (6 mechanical and 26 bioprostheses) isolated tricu spid valve replacement (TVR) from a total of 79 TVR and 375 tricuspid annul oplasties performed at the Montreal Heart Institute, between January 1978 a nd January 1998. Patients' ages ranged from 25 to 70 years (mean 48 years), and 62% were fem ales. Twenty-seven patients (84%) were in New York Heart Association (NYHA) functional class III and IV. Previous valve surgery had been performed in 22 patients (69%) of which 9 had undergone TVR. Postoperatively, permanent pacemaker was implanted in 9 patients (28%), and immediate reoperation was required in 2 patients because of bleeding. Mean follow-up period was 67.7 months (93% complete), Serial echocardiography showed 3 prosthesis dysfunct ions, leading to a second replacement in 2 patients at 12.8 and 7.7 years a fter initial surgery. All but three patients showed an improvement of their NYHA class. Hospital mortality occurred in 6 patients (19%) and 7 patients died during late follow-up: mean 38.1 months after surgery, including one valve-related death (mechanical valve thrombosis). Actuarial survival rate of all patients was 63% after 5 years, and 47% after 10 years. Isolated TVR remains a high-risk procedure. Most survivors, however, should expect a better quality of life with improvement in their NYHA class.