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DOI: 10.1055/s-0035-1544555
Determinants of Adverse Outcome of Isolated Tricuspid Valve Surgery
Background: The aims of the present study were to evaluate the postoperative mortality and to identify determinants of adverse outcome of isolated tricuspid valve (TV) surgery.
Methods: From January 2000 to August 2014, 70 patients underwent isolated tricuspid valve surgery. Preoperative demographic, echocardiographic and hemodynamic data were included. Independent risk factors for operative mortality were analyzed. Median age was 56 years, 46% of them were female.
Results: In-hospital mortality rate in our population was 8,57%, at 3-month follow-up 11,42%. Long-term mortality for the entire population was 21,4% at a mean follow up of 4,35 year. 1-year, 6-year and 10-year Kaplan-Meier survival analyses showed 89%, 81% and 74% survival rates, respectively. Univariable Cox proportional hazards analysis revealed that persistent infection over three months, atrial fibrillation, age, chronic obstructive lung diseases and impaired right ventricular function were significantly associated with early outcome, whereas hemodialysis patients with long-term outcome. Right sided endocarditis was with an incidence of 37% (n = 26) the most common indication for isolated TV surgery, 54% (n = 14) of them were cardiac device-related endocarditis and 15% (n = 4) drug abuse patients. In 16 patients (22%) the cause for TV surgery was associated with functional tricuspid regurgitation in adults with congenital heart disease (ACHD). In nine patients (13%) TV surgery was associated with secondary TV regurgitation. Five patients (7%) with previously heart transplantation underwent TV surgery in our institution. 100% postoperative survival rate was in patients with newly formed vegetations.
Conclusion: Surgical treatment of isolated TV diseases is associated with important postoperative mortality, however in our study with acceptable long-term outcome. Expeditious intervention with excision of the infected material is required to prevent occurrence of irreversible complications. Wait and Observe approach should be avoided. Long-standing infection, atrial fibrillation, age and COPD appear to determine prognosis.