Tricuspid valvectomy: Long-term survival and surgical options

Chait, Robert; Midwall, Jay

doi:10.1002/clc.4960290210

Cited by 9 publications

(9 citation statements)

References 2 publications

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“…Our results agree with others that surgical treatment of this unique group of endocarditis could be performed with good early and mid-term results [14][15][16].…”

Section: Discussionsupporting

confidence: 92%

“…However, up to 25% of these patients are not able to tolerate the tricuspid regurgitation. Excision without replacement (valvectomy) can be a viable alternative when other surgical methods are not feasible [14]. In our experience, valvectomy without any other procedure should be performed selectively in patients with low PAP and high risk of reinfection.…”

Section: Discussionmentioning

confidence: 97%

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Tricuspid Valve Endocarditis, a Single Center Experience to Reduce the Chance of Atrioventricular Block

Bakhshandeh¹

2017

AJCTS

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Background: Tricuspid Valve Endocarditis (TVE) in Intravenous Drug Abusers (IVDAs) is one of the leading causes of disability as it entails both cardiovascular and neurological complications which eventually usher in socioeconomic problems. The most practical approach is debated given variables such how to manage patients with elevated pulmonary artery pressures, what type of prosthetic valve to employ, how to mitigate the risk of post-operative reinfection, and strategies to reduce the possibility of development of Atrioventricular (AV) block. In this study, we present a novel technique for valve replacement to reduce or altogether eliminate the chance of developing AV block. Methods: Between December 2003 to November 2013, 243 consecutive patients with tricuspid valve endocarditis were enrolled in this study. This study was conducted in Imam Khomeini Hospital Complex, Tehran University of Medical Sciences. After January 2007 and whenever the septal leaflet was destroyed, and repair was not feasible, we sewed a double layer strip of pericardium along the septal leaflet annulus to make an anchoring cuff for Tricuspid Valve Replacement (TVR) stitches. The primary end point of this study was to compare the frequency of AV block following valve replacement before and after application of our novel technique. Results: All-cause mortality was in 27 (11.1%) patients. AV block was seen in 11 (22.9%) patients who underwent TVR. Mean survival in TVR patients with sinus rhythm after operation was 39.2 ± 4 months and in patients with AV block was 2.9 ± 1.2 months, (p-value: .000). In logistic regression analysis, developing AV block on the technique of TVR was statistically significant. Conclusion: In our findings, whenever resection of destroyed septal leaflet is inevitable, utilizing our novel technique of TVR is a practical strategy to reduce or altogether abolish the chance of developing AV block.

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“…Our results agree with others that surgical treatment of this unique group of endocarditis could be performed with good early and mid-term results [14][15][16].…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Tricuspid Valve Endocarditis, a Single Center Experience to Reduce the Chance of Atrioventricular Block

Bakhshandeh¹

2017

AJCTS

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“…[2][3][4] Significant TR is also present without significant left-sided valvular heart disease or myocardial disease, but the prognostic value of this isolated significant TR has not been established. As reported previously, even TV valvectomy can be performed without early post-operative mortality in patients with TV endocarditis, 5,6 which raises questions about the clinical significance of significant isolated TR. Although TV surgery may be recommended to symptomatic patients with severe TR, 2 the surgical benefit for asymptomatic significant isolated TR has not been demonstrated.…”

mentioning

confidence: 88%

Long-Term Prognosis of Isolated Significant Tricuspid Regurgitation

Lee

Song

Park

et al. 2010

Circ J

157

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Background:The prognostic implications and surgical benefit of isolated significant tricuspid regurgitation (TR) and prognostic factors in patients with TR were investigated. Methods and Results:In 870 consecutive patients with significant isolated TR, all-cause mortality was analyzed over 4.9±2.9 years. It was found that the survival rate tended to be higher in the 57 patients who underwent tricuspid valve (TV) surgery than the 813 patients who did not by using propensity-score matching (P=0.068), although it was not significant. Of the 813 patients that did not undergo TV surgery, the 5-year survival rate was 74%. According to the Cox proportional hazards model, the initial TR jet area (hazard ratio [HR], 1.044; 95% confidence interval [CI], 1.016-1.073), pulmonary artery systolic pressure (HR, 1.024; 95%CI, 1.017-1.032) and presence of right ventricular (RV) dysfunction (HR, 2.256; 95% CI, 1.329-3.828) were predictors of mortality independent of patient age and presence of diabetes mellitus and renal failure in medically managed patients. Conclusions:In patients with isolated significant TR, there was a tendency, although not significant, towards a higher survival rate after TV surgery. The severity of TR and pulmonary hypertension, and the presence of RV dysfunction are independent prognostic factors in medically managed patients. Further prospective randomized studies are necessary to demonstrate the benefit of TV surgery in these poor prognostic populations. (Circ J 2010; 74: 375 - 380)

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“…This has since been reaffirmed as an acceptable intervention in those with RSIE, especially if pulmonary artery pressure is normal. 2,4 However, if the patient has pulmonary artery hypertension, there may be significant risk for development of right heart failure with valvectomy alone.…”

Section: Discussionmentioning

confidence: 99%