Tricuspid valve surgery: a thirty-year assessment of early and late outcome

Eur J Cardiothorac Surg. 2008 Aug;34(2):402-9; discussion 409. doi: 10.1016/j.ejcts.2008.05.006. Epub 2008 Jun 25.


Objective: Tricuspid valve (TV) surgery is usually performed as a concomitant reconstruction procedure in addition to the correction of other cardiac pathologies. Isolated tricuspid procedures are exceptionally rare. Prosthetic valve replacement is also seldom required. Generally, these patients face a high risk of operative mortality and long-term outcome is poor. In this study we reviewed our experience with TV surgery focusing on risk factors for operative mortality, long-term outcome and incidence of valve related complications.

Methods: Retrospective analysis of 416 consecutive patients >18 years with acquired TV disease operated on between 1974 and 2003. The follow-up is 97% complete (mean 5.9+/-6.3 years). Three hundred and sixty-six patients (88%) underwent TV surgery with concomitant mitral (n=340) or aortic (n=100) valve surgery. The tricuspid valve was repaired in 310 patients (74.5%) and replaced in 106 (25.5%). A biological prosthesis was used in 68 patients (64%). Mean age at repair and replacement was 61+/-12.5 and 50+/-11.3 years, respectively (p<0.001).

Results: Overall 30-day mortality was 18.8% (78/416) and decreased from 33.3% (1974-1979) to 11.1% (2000-2003) (p< or =0.0001). Thirty-day mortality after TV repair and replacement was 13.9% (43/310) and 33% (35/106), respectively (p< or =0.001). Cox regression analysis revealed TV replacement as an independent predictor of 30-day mortality. Ten-year actuarial survival after TV repair and replacement was 47+/-3.5% and 37+/-4.8%, respectively (p=0.002). Forty-five patients (10.8%) required a TV re-operation after 7.7+/-5.1 years. Freedom from TV re-operation 10 years after TV repair and replacement was 83+/-3.6% and 79+/-6.1%, respectively (p=0.092).

Conclusions: Patients who require tricuspid valve surgery constitute a high-risk group. Tricuspid valve repair is associated with better perioperative and long-term outcome than valve replacement. However, patients undergoing replacement showed a significant higher incidence of risk factors for operative mortality. The incidence of re-operation is low with no significant difference when the tricuspid valve has been repaired or replaced. When valve replacement is necessary we recommend the use of a biological prosthesis considering the poor long-term survival.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Epidemiologic Methods
  • Female
  • Heart Valve Diseases / surgery
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / etiology
  • Reoperation / methods
  • Thromboembolism / etiology
  • Treatment Outcome
  • Tricuspid Valve / surgery*
  • Tricuspid Valve Insufficiency / surgery*
  • Tricuspid Valve Stenosis / surgery*