Long Term Outcomes Of Tricuspid Valve Replacement.

Introduction The tricuspid valve has historically received less attention than any other cardiac valve. However, tricuspid disease is not a benign entity. Current practice is largely based on tricuspid valve repair since tricuspid valve replacement has been associated with high mortality and poor long-term outcomes. Objectives We aimed at evaluating the short and long-term outcomes of patients who underwent isolated tricuspid valve replacement at our institution. Materials and Methods We included in this retrospective study 12 consecutive patients who underwent to tricuspid valve replacement between October 2000 and October 2018. Clinical, surgical, pre and post-op echocardiographic findings were analyzed. In all cases bioprostheses were used. Results The mean age was 65±16.3years and 66.7% were female. The etiology of tricuspid valve disease was failure of previous tricuspid repair in rheumatic fever cases (5 patients), infective endocarditis (3 patients), leads in the right ventricle (2 patients), primary tricuspid regurgitation due chordal rupture (1 patient), and congenital disease due to Ebstein´s anomaly (1 patient). Three-quarters of the patients were in NYHA class III/IV, 58.3% had atrial fibrillation and 33.3% were diabetic. The mean tricuspid annulus diameter was 49±3.3 and 33.3% of patients had moderate to severe right ventricular dysfunction. The mean extracorporeal circulation time was 82±29.2min, the mean aortic cross-clamp time was 41±29.6min Cardioplegic arrest was used in all but 3 patients in whom ventricular fibrillation was used. Half of the population (6 patients) needed inotropic support in the first 24 hours and 3 patients needed permanent pacemaker due third-degree atrioventricular block. There was no operative mortality and after a follow-up of 5.2±5.5 years, 30-day and late mortalities were 16.7% (2 patients) and 25% (3 patients), respectively. NYHA class and right heart failure symptoms significantly improved during follow-up of the survivors. No patient required reoperation. Late survival was 75±12.5%. Conclusions Survivors had significant improvement in the NYHA class and freedom from right heart failure symptoms. Bioprostheses for tricuspid valve replacement have a very good long-term durability. Third degree of atrioventricular block, mostly appearing in early postoperative period, was the most common and severe complication of tricuspid valve replacement.