Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease

Objectives: We have reviewed 260 patients who underwent initial tricuspid v alve surgery for functional tricuspid valve regurgitation (TR) and analyzed independent predictors for early and late unfavorable results. Materials a nd methods: Between 1981 and 1998, 260 tricuspid valve operations were perf ormed for functional TR. There were 94 males and 166 females with a mean ag e of 55 years. The tricuspid valve surgery procedures consisted of De Vega tricuspid annuloplasty in 240 patients, ring annuloplasty in four patients, and tricuspid valve replacement in 16 patients. The mean duration of follo w-up was 7.8 years. Results: Hospital mortality was 8.9% (23 patients). Lat e deaths occurred in 34 patients including cardiac-related late deaths in 2 6 patients. The survival rates were 83 +/- 2% at 5 years and 78 +/- 3% at 1 0 years. Late tricuspid valve reoperation was performed on 13 patients due to residual or recurrent TR in 12 patients and thrombosed tricuspid bileafl et mechanical valve in one patient. The tricuspid valve reoperation-free su rvival rate was 90 +/- 2% at 5 years and 84 +/- 3% at 10 years. The only pr edictor of hospital mortality was preoperative highly elevated right atrial pressure (P = 0.01). Variables predictive of cardiac-related late death we re preoperative New York Heart Association (NYHA) class IV (P = 0.01) and p oor left ventricular ejection fraction (LVEF) (P = 0.02). Residual TR of mo re than grade 2+ early after tricuspid annuloplasty was a significant risk factor for late tricuspid valve reoperation (P = 0.01). Preoperative TR of grade 4+ was predictive of early residual TR (P = 0.04). Conclusions: Tricu spid valve surgery for functional TR can be performed with acceptable level s of early mortality. Cardiac-related late mortality after tricuspid surger y may be improved by earlier surgical treatment before NYHA class IV or det erioration of LVEF occurs. To prevent late tricuspid reoperation, it is imp ortant not to leave residual TR of grade 2+ or more after tricuspid annulop lasty. (C) 2001 Elsevier Science B.V. All rights reserved.