Aspectos pronósticos de la cirugía aislada de sustitución valvular tricuspídea

Abstract

BackgroundIsolated tricuspid valve replacement (TVR) is a rarely performed procedure, with controversial indications for performing surgery, mostly due to the poor outcomes reported. Material and methodsAll patients undergoing isolated TVR between 2003 and 2014 were included. We analyzed: a) Perioperative mortality and long-term mortality; b) Prosthetic valves related complications during follow-up (thrombosis and biological valve deterioration). ResultsA total of 40 patients underwent isolated TVR during the study period. 82.5% of these patients where in III-IV/IV NYHA functional class, and 70% of them had at least moderate pulmonary hypertension (mean PAP>40mmHg). Perioperative mortality was 25%. The EuroSCORE I underestimated the mortality associated to this procedure (estimated mortality of 13.89%). Preoperative anemia (OR: 0.52; CI 95%: 0.30-0.89; P=.017) was associated to a higher perioperative mortality. There was a trend towards a higher mortality in patients with previous cardiac surgery (P=.081). Late survival, after 44 months of median follow-up, was 57.50%. Long-term survival was influenced by: 1) Severe pulmonary hypertension (OR: 5,77; CI: 95%: 1.06-31.26; P=.042); 2) NYHA class IV (OR: 8.31; CI: 95%: 1.48-49.06; P=.004). Patients who were operated in NYHA IV had a poor long-term survival (12.5% of one-year survival, log Rank P=.004). ConclusionsIsolated TVR is associated to a high mortality, mostly due to surgery timing, when the patient is already in an advanced heart failure situation.Indication for surgery must be done promptly, before the right ventricle function deterioration or the development of severe pulmonary hypertension. Performing surgery when the patient is in IV NYHA functional class, provides scarce benefit regarding long-term survival.