Introduction: Most interventions on the tricuspid valve are performed as a concomitant procedure, usually accompanying left sided valve surgery. In the past, non-severe TR was left untreated. Over the last few years there is evidence that even annular dilatation warrants intervention. The consequences of severe TR are right sided failure, with eventual failure of vital organs such as kidneys or liver. Once patients develop cirrhosis, the prognosis is poor, and surgical risk is high. We reviewed our experience with reoperation for severe TR, and compared outcomes to patients undergoing tricuspid repair during first-time surgery.
Patients: There were 73 patients: prior surgery included tricuspid valve annuloplasty in 7, mitral valve replacement in 44, aortic valve replacement in 17, and CABG in 16. In the first-time group there were 358 patients. The addition of a tricuspid procedure during first-time surgery adds 24 and 21 minutes to CPB and XCT times. In patients undergoing reoperation, creatinine and albumin levels were 1.3 ± 1.2 and 4 ± 0.5 respectively. EuroSCORE was 17 ± 15.
Results: In surgery for TR the operative mortality was 11% (n=41) in the primary group and 25% (n=18) in the reoperation group (p=0.003). Survival at 1,3 and 5 years was 76%, 73% and 66% in the primary group and 63%, 56% and 48% in the reoperation group (p=0.007).
Conclusions: Deterioration in the degree of TR cannot be foreseen. Therefore patients with TR of moderate or greater degree, or those having a dilated annulus even in the absence of TR, should undergo concomitant tricuspid annuloplasty at the time of surgery for left sided valves. The operative risk at repeat surgery is high, and is probably correlated with systemic organ dysfunction. Patients after prior heart surgery who do develop TR should be referred for repeat surgery at an early stage in order to minimize the operative risk.
