Early and Midterm Outcomes for Tricuspid Valve Surgery After Left-Sided Valve Surgery

Abstract

The purpose of this study was to compare the early and midterm results of tricuspid valve replacement (TVR) versus tricuspid valve repair (TVr) for late tricuspid regurgitation after left-sided valve surgery. Fifty-one consecutive patients who underwent tricuspid valve surgery after left-sided valve surgery between January 1995 and April 2008 were included. Thirty-seven patients underwent TVR, and 14 patients underwent TVr. Tricuspid valve replacement was performed along with concomitant procedures in 27 patients (73.0%). Patients undergoing TVR were more likely to have severe tricuspid regurgitation (64.3% versus 89.2%; p = 0.037), or a previous history of tricuspid regurgitation repair (7.1% versus 51.4%; p = 0.004). There was no hospital death in both TVr and TVR groups. However, in comparison to TVr patients, TVR patients needed a greater amount of hemofiltration (59 +/- 23 versus 80 +/- 36; p = 0.026) and had longer periods of hospital stays (13.5 +/- 4.4 versus 26.9 +/- 25.7 days; p = 0.049). Survival rates at 1, 5, and 10 years were 97%, 93%, and 63% for patients undergoing TVR, and 93%, 93%, and 81% for patients undergoing TVr, respectively. There was no statistical difference in midterm survival rates between the two groups. Cox regression analysis revealed that left ventricular ejection fraction of 0.40 or less (p = 0.034) and age (p = 0.035) were independent predictors of late mortality after TVR or TVr. Patients undergoing TVR had a more advanced preoperative tricuspid regurgitation grade and significantly prolonged hospital stays. However, there were no statistical differences in early and midterm outcomes between the two groups.