Evaluación retrospectiva de la sustitución valvular tricúspide en el tratamiento de las valvulopatías adquiridas

Abstract

Acquired tricuspid valvular heart disease maintains interest among cardiovascular surgeons because we now have an undisputed technique that has definitely solved the ``tricuspid challenge". the disappearance of rheumatic disease in developed countries has ignored our failure, which will be evident in developing countries when they have access to the world's advanced diagnostic and surgical techniques.In the 1970s and 1980s in spain, we identified this problem and faced it with a solution that we understood better, though not without mistakes, mainly the lack of identification of groups of risk before surgery: pulmonary hypertension with fixed high resistances versus rheumatic poly-valvulitis in young patients in short evolution.Our results matched those of other groups, with late mortality growing exponentially 10 years after surgery, which highlighted the risk of tricuspid valve replacement. it also occurs in the conservative attitude to annuloplasty repair that frequently leads to reoperation because of failure of the repair or an unacceptable quality of life in stages III and IV.We argue for the indication of mechanical valves for surgery involving tricuspid valve replacement when other prostheses in the left position were or need to be implanted. unlike other groups, we believe that the deterioration of a bioprosthesis, especially in younger patients, necessitates a second and often a third intervention.The tricuspid challenge will reappear in developing countries.