Isolated reoperative tricuspid valve surgery: Outcomes and risk assessment

Abstract

Objective To describe patient characteristics and post-operative outcomes, including early and late mortality, defined by death within 30 days and after 30 days post-surgery, respectively, as well as 20-year survival after isolated reoperative tricuspid surgery. Methods We retrospectively analyzed 169 patients who underwent isolated reoperative tricuspid valve surgery at our institution (between 1997 and 2000) and describe post-surgical outcomes including intraoperative, early and late mortality. All patients included completed 21 years of follow-up. Results The majority of our patients were females 147 (87%) with the mean age of 45.9 ± 12.9 years. The mean body mass index (BMI, kg/m 2 ) was 27.4 ± 6.0. Previous cardiac surgeries included tricuspid valve surgeries in 169 (100%) patients, with bioprosthetic valves, mechanical valves, annual rings and tricuspid repair surgeries utilized in 37 (21.9%), 21 (12.4%), 38 (22.4%) and 73 (43.2%) patients, respectively. The indication for previous tricuspid surgery was rheumatic heart disease in 154 (91.5%) patients. The most common cause of reoperative valvular surgery was tricuspid regurgitation (TR) in 139 (82.2%), with 66% of patients having severe TR. Other reasons for reoperative surgery included tricuspid stenosis 22 (13%) and dehiscence 8 (4.7%). For the redo surgery, 125 (74%) patients underwent Tricuspid Valve Replacement (TVR), 90 (53%) of whom received bioprosthetic valves while 35 (21%) received mechanical valves. Forty-four patients (26%) underwent Tricuspid Valve Repair. Mortality within 30 days of surgery was 11.3% (20 patients) and 11.4% after 30 days, with 20 years survival being about 80%. Conclusions Based on our experience, reoperation for failed isolated tricuspid valve replacement or repair was associated with reasonable mortality and good survival rate over long period of time.

Outcomes of minimally invasive isolated tricuspid valve repair and replacement through right mini-thoracotomy

“… 10 , 11 Other studies have reported in-hospital mortality rates within a varying range of 10 to 13%. 12 , 13 , 14 The individualized perioperative care provided by a single surgeon in our Mini-TVS experience may have contributed to the positive surgical outcomes in this cohort. Furthermore, our previous ITV national outcomes study showed no difference in in-hospital mortality between TVR and TVre.…”

Transjugular tricuspid valve‐in‐ring replacement using the novel system under three‐dimensional printing guidance

“…Recently, TVIR replacement has been introduced as an appealing alternative for TR after failed surgical annuloplasty, with initial reports showing successful clinical outcomes. 2 , 3 , 4 , 5 , 6 While comparing with tricuspid valve‐in‐valve replacement, TVIR in general encounters the increasing complexity in pathological structure and has higher risk of developing complications: (i) In contrast to the geometry of the left‐sided valve annulus, which is circular, the geometric dimensions of the dilated TA after surgical annuloplasty repair are larger, oval, and non‐planar. 2 (ii) It is difficult to maintain the prosthesis coaxially with the TA after surgical annuloplasty repair in cases with severe TR and a giant right atrium.…”

“…Recurrent tricuspid regurgitation (TR) is observed in over 10% of patients in the short‐term follow‐up after prior surgical annuloplasty procedures, leading to increased mortality rates and unfavourable clinical outcomes 1 . Similarly, a surgical reoperation is a less effective way to deal with recurrent TR because of its historically high risk and high postoperative mortality 2 . For these patients, transcatheter tricuspid valve‐in‐ring (TVIR) replacement has emerged as a viable alternative to high‐risk surgical reoperation for failed annuloplasty rings.…”

“… 1 Similarly, a surgical reoperation is a less effective way to deal with recurrent TR because of its historically high risk and high postoperative mortality. 2 For these patients, transcatheter tricuspid valve‐in‐ring (TVIR) replacement has emerged as a viable alternative to high‐risk surgical reoperation for failed annuloplasty rings. However, the existing devices for interventional therapy are currently being utilized in ‘off‐label’ manners and pose potential challenges for the TVIR concept.…”

Transthoracic echocardiographic Doppler metrics in evaluating bioprosthetic tricuspid valve dysfunction

“…Managing such patients presents challenges, and the mortality associated with a repeat TV surgery remains high. This underscores the critical importance of evaluating the function of prosthetics TV 1,2 Echocardiography plays a crucial role in evaluating tricuspid prostheses. Given the anterior position of the TV, transthoracic echocardiography (TTE) generally offers satisfactory assessment of prosthetic TV 3 .…”