Tricuspid valve surgery: a thirty-year assessment of early and late outcome

Objective: Tricuspid valve (TV) surgery is usually performed as a concomitant reconstruction procedure in addition to the correction of other cardiac pathologies. Isolated tricuspid procedures are exceptionally rare. Prosthetic valve replacement is also seldom required. Generally, these patients face a high risk of operative mortality and long-term outcome is poor. In this study we reviewed our experience with TV surgery focusing on risk factors for operative mortality, long-term outcome and incidence of valve related complications Methods: Retrospective analysis of 416 consecutive patients >18 years with acquired TV disease operated on between 1974 and 2003. The follow-up is 97% complete (mean 5.9 ± 6.3 years). Three hundred and sixty-six patients (88%) underwent TV surgery with concomitant mitral (n = 340) or aortic (n = 100) valve surgery. The tricuspid valve was repaired in 310 patients (74.5%) and replaced in 106 (25.5%). A biological prosthesis was used in 68 patients (64%). Mean age at repair and replacement was 61 ± 12.5 and 50 ± 11.3 years, respectively (p < 0.001). Results: Overall 30-day mortality was 18.8% (78/416) and decreased from 33.3% (1974-1979) to 11.1% (2000-2003) (p ≤ 0.0001). Thirty-day mortality after TV repair and replacement was 13.9% (43/310) and 33% (35/106), respectively (p ≤ 0.001). Cox regression analysis revealed TV replacement as an independent predictor of 30-day mortality. Ten-year actuarial survival after TV repair and replacement was 47 ± 3.5% and 37 ± 4.8%, respectively (p = 0.002). Forty-five patients (10.8%) required a TV re-operation after 7.7 ± 5.1 years. Freedom from TV re-operation 10 years after TV repair and replacement was 83 ± 3.6% and 79 ± 6.1%, respectively (p = 0.092). Conclusions: Patients who require tricuspid valve surgery constitute a high-risk group. Tricuspid valve repair is associated with better perioperative and long-term outcome than valve replacement. However, patients undergoing replacement showed a significant higher incidence of risk factors for operative mortality. The incidence of re-operation is low with no significant difference when the tricuspid valve has been repaired or replaced. When valve replacement is necessary we recommend the use of a biological prosthesis considering the poor long-term survival.