Similar Mid-term Results with Isolated Tricuspid Valve Replacement – Implications for Clinical Decision Making

Objective: Tricuspid valve (TV) pathology is relatively common and carries a significant impact on both quality of life and prognosis. Currently, patients are referred to surgery relatively late and the operative results are accordingly, suboptimal, especially for patients with isolated TV pathology who do not require intervention for left sided valves and are believed to be at higher risk. We reviewed our institutional results to verify this hypothesis and its possible implication on future treatment

Methods: Retrospective analysis of all patients undergoing TV replacement (TVR) surgery between 2007-2018 in two centers. Patients characteristics and postoperative adverse events, including mid-term mortality and change in right ventricular (RV) function, were analyzed in patients who underwent isolated vs. combined TVR

Results: TVR was performed in 78 patients; mean age was 58±13 years and 35% were males. Baseline characteristics were similar in patients undergoing isolated TVR (n=38) compared to combined valvular surgery (n=39) with the only main difference being the number of acute endocarditis patients (24% in the isolated group vs. 8% in the combined, P=0.053). Bypass times and cross clamp times were significantly shorter in isolated TVR (P<0.001). During a median follow-up of 29 months (IQR, 10-76 months) 26 (33%) patients died. Mid-term mortality rates were not significantly different between isolated (14/38 patients, 36.8%) and combined (12/40 patients, 30%) TVR surgery (p=0.522). There was also no difference in the change in RV function from baseline between groups. Additional postoperative adverse events including stroke, bleeding, need for renal replacement therapy, and need for pacemaker were not significantly different between groups

Conclusions: In this cohort of patients undergoing TVR, there was no significant difference in postoperative and mid-term morbidity and mortality in patients undergoing isolated vs. combined surgery. These results should perhaps lead to a more aggressive approach towards patients requiring isolated TVR