Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement

Abstract

Background: Isolated tricuspid valve (ITV) operations are infrequent and the decision to operate is controversial. We report a series of ITV operations to outline the current disease status requiring this uncommon procedure with an emphasis on the results of tricuspid valve repair (TVr) versus replacement (TVR).Methods: Using our prospective cardiac surgery database, 57 patients who underwent ITV operations between 01/02-03/14 were identified. Median follow up time was 3.5 years [interquartile range (IQR), 0.8-6.7 years].Results: Fifty-seven patients underwent ITV surgery with a mean age of 54.4±14.9 yrs and 61% were women. Baseline characteristics were similar between patients who underwent TVr (n=18) or TVR (n=39).The etiologies of TV dysfunction were: ITV endocarditis 14/57 (25%), persistent TV regurgitation after left-sided valve surgery in 12/57 (21%), traumatic biopsies and iatrogenic injury from pacing leads in 11/57 (19%), orthotopic heart transplant 9/57 (16%), carcinoid syndrome 3/57 (5%), congenital 2/57 (5%) and idiopathic 5/57 (9%). Overall, 32/57 (56%) patients had prior heart surgery; of which 10/32 (31%) were TV procedures. Bioprosthetic prostheses were used in 34/39 (87%) patients. Of those who had repair, 11/18 (61%) had ring annuloplasty, 3/18 (17%) bicuspidization, and 3/18 (17%) De Vega annuloplasty and one had vegetectomy. Operative mortality was 5.1% (n=2) and 16.7% (n=3) for TVR and TVr groups, respectively (P=0.32), with an overall mortality rate of 8.6%. Postoperative complications included new onset renal failure in 6/39 (15%) of TVr and 2/18 (11%) of TVR (P=0.71) and there were no strokes. Overall survival rates and degree of residual RV dysfunction were similar for the two groups (both P=0.3). Five-year survival was 77% and 84% for TVr and TVR respectively (P=0.52). There was no difference in rates of recurrent tricuspid regurgitation for TVr and TVR (35.7% vs. 23.5%, respectively, P=0.4).Conclusions: ITV surgery is associated with improved but still relatively high operative mortality. Midterm outcomes for TVr and TVR are similar with regards to postoperative complications, survival, and freedom from recurrent tricuspid regurgitation.

Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients

“…A total of 811 entries were obtained from the literature search, and figure 1 summarises the studies disposition. After abstract screening, 54 full-text studies were evaluated before arriving at the final 16 studies that met the inclusion criteria of this meta-analysis 6–21Table 1. lists the main characteristics of the included studies, totalling 6808 isolated tricuspid valve repairs and 8261 isolated tricuspid valve replacement patients.…”

Three-Dimensional Echocardiography Reveals Extensive Congenital Anterior Tricuspid Valve Prolapse

“…3 Although the prevalence of severe TV disease is on the rise, 4 surgery for isolated TV disease is rarely performed despite these recommendations, because of the relatively high in-hospital mortality rate. 5,6 Previous studies have reported that the 2-year event-free survival rate following TV surgery in patients with preoperative severe RV dysfunction is 57%. 7 Cases of isolated TV surgery are limited in number in comparison with those of aortic or mitral valve repair.…”

Transcatheter Tricuspid Valve Replacement: Principles and Design

“…Surgical TV repair is seldom performed for isolated TV disease (13% of surgical cases) ( 20 ). Furthermore, surgery for TR can be associated with a high risk of morbidity and mortality, with perioperative mortality reaching up to 10% in selected cases ( 1 , 21 ). For these patients, new percutaneous transcatheter approaches may address this unmet clinical need.…”