Tricuspid valve replacement for acquired isolated tricuspid valve disease: Mid-term results

Objectives: Isolated tricuspid valve replacement (TVR) for acquired tricuspid valve disease is rare. We studied the etiologies leading to TVR, the preoperative conditions and the postoperative outcome of patients who underwent isolated TVR at our institution. Material and Methods: From the clinical database we identified all patients (n=126) who underwent TVR between 01.01.1985 and 31.07.2003. We encountered 28 consecutive patients (16 female, mean age 53,6 years) who underwent 30 isolated TVR for acquired tricuspid valve insufficiency (TVI). Results: The mean follow-up time for these patients averaged 38 (1–221) months. TVI was caused in 2 patients by infective, in 7 patients by healed endocarditis, 1 patient suffered from healed perimyocarditis, 2 from hypertrophic non-obstructive cardiomyopathy and one from endomyocardial fibrosis. In one patient TVI was related to constrictive pericarditis and in 4 patients to prior heart transplantation. 2 patients underwent previous TVR and one tricuspid valve resection in other institutions. 20 patients received mechanical valves, 10 bioprostheses. One patient died perioperatively (3.6%), 6 during the follow-up time (21%). Two patients underwent a redo-operation, one due to prosthetic endocarditis, the other one after thrombosis of a mechanical prosthesis. Of the surviving patients 20 were in NYHA functional classes 0-I and one in II-III at the time of follow-up. Conclusions: Isolated TVR for acquired TVI is rarely performed and due to a multitude of different etiologies. Perioperative mortality and morbidity and prostheses related complications are comparatively lower than previously reported. The long-term results are largely dependent on the etiology of the regurgitation and the patients' comorbidity.