Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease

Background. Organic tricuspid valve ( TV) disease is uncommon. Few studies have compared TV repair with replacement in these patients. The current study compared midterm outcomes of TV repair versus replacement in a large group of patients with organic tricuspid disease. Methods. Two-hundred and fifty patients underwent surgery for organic TV disease at our institution from 1979 to 2003. Clinical and echocardiographic follow-up were obtained, were 99% complete, and were 5.2 +/- 4.1 years long ( mean +/- standard deviation). Results. One hundred and seventy-eight patients ( 71%) underwent TV repair and 72 ( 29%) received TV replacement ( 54 bioprosthetic, 18 mechanical). Repair patients were more likely to have hypertension, rheumatic pathology, or elective surgery. Concomitant procedures included mitral ( 50% of patients), aortic ( 26%), and coronary bypass ( 6%) operations. Perioperative and midterm mortality were higher in the replacement group ( both p < 0.001). Cox regression analysis revealed TV replacement as an independent predictor of midterm mortality ( hazard ratio: 5.1, 95% confidence interval: 2.9 to 9.1, p < 0.001) and decreased event-free survival ( hazard ratio: 2.0, 95% confidence interval: 1.1 to 3.6, p = 0.02). Follow-up echocardiography revealed more moderate to severe tricuspid regurgitation in repair patients ( 38% vs 5%, p < 0.001), but no difference in New York Heart Association functional class or reoperation rates. Conclusions. Tricuspid valve repair is associated with better perioperative, midterm, and event-free survival than TV replacement in patients with organic tricuspid disease. Despite more tricuspid regurgitation in the repair group during follow-up, reoperation rates and functional class were similar. Repair should be performed whenever possible in patients with organic tricuspid disease.