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Surgery For Late Rheumatic Tricuspid Regurgitation With Previous Left Heart Valve Surgery - Repair Vs. Replacement.

Tim W. Au, Lik C. Cheng, Shui W. Chiu, Danial T. Chan.
Queen Mary Hospital, University of Hong Kong ,, Hong Kong, Hong Kong.


OBJECTIVE:
The aim of this study was to compare the in-hospital mortality and mid-term outcome undergoing tricuspid replacement versus repair surgery for late significant rheumatic tricuspid regurgitation.
METHODS:
Retrospective review of our data between January 2000 and August 2009. Out of 497 patients underwent tricuspid valve surgery in our institution, 173 patients had rheumatic disease with previous valves surgery performed. Fifty seven patients had tricuspid replacement [100% bioprothesis]. In the repair group, 41 patients had simple De Vega annuloplasty and 75 patients had annuloplasty band. EuroSCORES of the tricuspid replacement group and repair group were 7.6 and 7.9 respectively. Twenty-one percent of the replacement group had previous tricuspid valve surgery compared to only 9% in the repair group [p=0.024]. Concomitant procedures included mitral [56%], aortic [44%] and CABG [4%]. Follow up was 96% complete with mean 3.8 ± 2.4 years.
RESULTS:
The in-hospital mortality [16 death] was 11% for the replacement group compared to 9% for the repair group [p=0.75]. Univariate analysis showed male sex, LVEF<30%, cardiogenic shock, active endocarditis, ventilation pre-op, pulmonary hypertension, creatinine>200 mmol/L and emergency were significant risk factors. Multivariate analysis revealed cardiogenic shock was the only significant factor [p=0.002 and Exp(B)=42.5] for in-hospital mortality. Post-operative complications were seen in 42% of the replacement group compared to 62% in the repair group. Late death occurred in 26 patients. The actuarial survival were 52% and 60% respectively for the replacement and the repair group at 8 years [Log-rank p=0.39].
CONCLUSIONS:
Surgery for late rheumatic tricuspid regurgitation carried considerable morbidity as well as mortality. However, tricuspid replacement had similar in-hospital mortality compared to tricuspid repair. Medium term outcome also did not showed significant difference between the 2 groups.
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