Invited Commentary

Abstract

Jeganathan and colleagues [1Jeganathan R. Armstrong S. Al-Alao B. David T. The risk and outcomes of reoperative tricuspid valve surgery.Ann Thorac Surg. 2013; 95: 119-125Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar] present a series of patients that is unique in that 49 patients had tricuspid valve reoperation after previous tricuspid valve repair. Many series have shown that approximately half of all tricuspid valve surgery is performed as a reoperation, but most of those patients did not have previous tricuspid valve surgery and were in fact undergoing tricuspid valve operation for the first time. Sufficient detail is provided in this series to allow some valuable clinical insights. First, most patients undergoing reoperation after prior tricuspid repair for functional pathology can do well with a repeated repair. Second, patients with organic tricuspid pathology undergoing reoperation after prior tricuspid repair generally require tricuspid valve replacement. Third, the short- and long-term results of tricuspid reoperation can be better than previously reported, with an in-hospital mortality of 13% and a 10-year survival of 64% in this series. While the above concepts are relatively new, this series also emphasizes some additional points that have been made previously. First, operation on patients with tricuspid regurgitation before being determined as NYHA class III/IV gives better outcome than later operation. Second, tricuspid annuloplasty alone might not be sufficient at the time of initial repair for patients with myxomatous tricuspid valve disease. Third, epicardial lead placement should be considered for patients needing permanent pacing wires after tricuspid valve surgery. Some issues in tricuspid valve surgery remain unaddressed by this series, including how best to address the patient who held already has endocardial pacing leads, what is the frequency of late tricuspid regurgitation in patients undergoing second-time tricuspid valve repair, what techniques are optimal for tricuspid repair, and which patients should have mechanical versus biological tricuspid valve replacement. Although the tricuspid valve is among the least operated valves, growing evidence suggests that more aggressive surgical treatment for tricuspid regurgitation at the time of other cardiac surgery is warranted. The insights from this series should facilitate more durable surgery for tricuspid regurgitation by more appropriate repair versus replacement, more effective repair technique, and avoidance of issues such as subsequent transvenous lead placement. The Risk and Outcomes of Reoperative Tricuspid Valve SurgeryThe Annals of Thoracic SurgeryVol. 95Issue 1PreviewOutcomes after tricuspid valve reoperation have not been published before. This study examines our 32-year experience in this cohort of patients. Full-Text PDF