Tricuspid Reoperation After Left-Sided Rheumatic Valve Operations

Background. The management of late tricuspid regurgitation after left-sided valve operations in rheumatic patients remains controversial. The aim of this study was to analyze clinical and echocardiographic outcomes of tricuspid valve procedures after left-sided valve operations in rheumatic patients. Methods. This study enrolled 106 rheumatic patients with a history of left- sided valve operations who were undergoing tricuspid valve procedures (53 replacements, 53 repairs). Follow-up was 97% complete, with a mean follow- up of 62 +/- 42 months. Clinical and echocardiographic data were analyzed. Results. The early mortality rate was 1.9% (2 of 106 patients). There was no significant difference in cumulative survival at 10 years between patients who underwent tricuspid valve replacement (63.1% +/- 13.2%) or repair (80.7% +/- 0.8%, p = 0.317). Multivariable Cox regression analysis revealed that old age (hazard ratio [HR], 6.5; p = 0.007), anemia (HR, 10.9; p = 0.004), and left ventricular ejection fraction of less than 0.4 (HR, 10.3; p = 0.001) were predictors of major adverse cardiac events. Among patients who underwent tricuspid valve repair, multivariate analysis revealed that the aortic transprosthetic mean pressure gradient at late follow- up was an independent predictor of late tricuspid regurgitation. Conclusions. Tricuspid valve procedures after left-sided valve operations in rheumatic patients can be performed at low risk with good clinical outcomes. For improved clinical outcomes, early surgical intervention should be considered before the development of anemia and left ventricular dysfunction. A lower aortic transprosthetic mean pressure gradient may help prevent late progression of tricuspid regurgitation in a clinical setting. (C) 2013 by The Society of Thoracic Surgeons