Tricuspid valve replacement: an appraisal of 45 years of experience

Abstract

OBJECTIVES This study provides an overview of the change over a 45-year time period in the characteristics and outcome of patients with tricuspid valve disease undergoing surgical tricuspid valve replacement (TVR). METHODS The characteristics and outcomes of all consecutive TVRs from November 1972 to November 2017 at Erasmus MC were collected retrospectively. A logistic regression analysis was conducted to identify the significant predictors of 30-day mortality. Multivariable Cox regression analysis was used to identify the potential risk factors of patient outcome and the effect of time on these factors. RESULTS Ninety-eight patients with tricuspid valve dysfunction underwent 114 consecutive TVRs at a mean age of 50.1 ± 17.2 years (68.5% female). Aetiology changed over time from predominantly functional regurgitation (42.9% in 1972-1985) to predominantly carcinoid heart disease (47.7% in 2001-2017). Early mortality declined significantly from 35% in 1972–1985 to 6.7% in 2001–2017 (P < 0.001). Over time, the hazard ratio of late mortality decreased for higher New York Heart Association class, lower preoperative haemoglobin, and high central venous pressure and increased for the presence of preoperative leg oedema, higher creatinine and alkaline phosphatase. The late survival was 43.8% ± 5.89% at 10 years and was comparable among eras (P = 0.44). The cumulative incidence of reoperation at 10 years was 14.1% (2.3–26.0) in biological valves and 4.9% (0.1–10.3) in mechanical valves (P = 0.25). CONCLUSIONS Patient characteristics, potential risk factors and patient outcome changed considerably over time in patients undergoing TVR. Notably, there was a shift in aetiology, completely altering the patient population and their characteristics.

Mechanical Tricuspid Valves Have Higher Rate of Reintervention: A Single Center Experience

“…The outcomes of TVR have improved recently; however, they are still not optimal. This study presented the early and late TVR outcomes in 159 patients with a 4) and Filsoufi and colleagues had 20% mortality. 7) The reported mortality was as low as 3% in other reports.…”

“…Veen and coworkers found that mechanical valves were associated with better hospital survival and explained this finding with the time era's effect since they used mechanical valves more frequently in recent years. 4) More than half of the patients included in this study had preoperative atrial fibrillation. However, none of those patients had maze procedure.…”

“…1) Despite recent advances in TV surgery, TVR is associated with high mortality, reoperation, and hospital readmission. 4) Our primary objective was to compare the composite outcome of heart failure (HF) admission and TV reintervention in patients who underwent TVR with mechanical versus tissue valves in our population. The secondary objective was to report the hospital outcomes that were defined as those occurring during the indexed hospital admission or 30 days of the indexed operation.…”

Influence of Tricuspid Regurgitation After Heart Transplantation: A Single-center Experience

“… 3 , 9 Surgical management options include Carpentier’s ring annuloplasty, De Vega technique, and valve replacement. 10 - 12 Other publications postulate that, in most cases, significant TVR improves within the first postoperative year after transplantation without intervention. 2 …”

Unmasking pulmonary hypertension following tricuspid valve replacement

“…2 Recently published data have shown promising results in terms of improved clinical outcomes and mortality rates following surgical correction of TV pathology, and hence, it is being -utilized more frequently over the recent years. [3][4][5] Optimal outcomes are obtained when the surgery is performed prior to the development of advanced RV dysfunction with significant improvement of RV function expected following correction of TR 6 ; however, various other hemodynamic changes are yet to be explored following this procedure, especially, the early and late changes on the pulmonary circulation.…”