Valve Repair or Replacement for Isolated Tricuspid Valve Pathology? A Single-center Long-term Follow Up

Objectives: Systematic long-term data on isolated tricuspid valve surgery are limited. The aim of this study was to compare tricuspid valve replacement versus reconstruction for isolated TV pathology.

Methods: Between February 1995 and June 2011, a total number of 109 consecutive patients underwent isolated tricuspid valve surgery at University Hospital of Heidelberg: 41 (37.6%) received tricuspid valve repair (TVR) and 68 (62.3%) underwent tricuspid valve replacement (TVE). Detailed information about patient demographics, preoperative cardiovascular risk factors, cardiac function assessed by two-dimensional echocardiograms, intraoperative characteristics and as well as the postoperative outcomes including long-term survival were compared.

Results: There were no statistically significant differences between the two groups regarding age (50.7 ± 19.4 years in the TVR group versus 55.7 ± 15.9 years in the TVE group, p = 0.163), gender distribution (43.9% versus 54.4% of female patients in the TVR and TVE groups, respectively, p = 0.305) and body mass index (24.5 ± 5.2 in the TVR group versus 24.9 ± 6.9 in the TVE group, p = 0.713). Also, there were no significant differences regarding preoperative angina and dispnoa status, liver, renal and pulmonary function, infections, hemodynamic status and cardiovascular risk factors. Whereas there were no significant differences between the two groups in terms of previous coronary (p = 0.481), aortic valve (p = 1.000), mitral valve (p = 0.530) or pulmonary valve surgery (p = 1.000), patients from the TVE group had significantly higher rate of previous tricuspid valve repair (p = 0.013). There were no statistically significant differences regarding postoperative arrhythmias, the need for intra-aortic balloon pump or ventricular assist device. Also, both groups were comparable in terms of inotropic support requirement. However, significantly more patients from the TVE group required Noradrenalin support postoperatively (50.0% in the TVE group versus 24.4% in the TVR group, p = 0.014). Both groups had similar incidence of renal failure requiring conservative treatment of dialysis/hemofiltration. There was no significant difference in long-term survival with up to 12 years follow-up (Log Rank p = 0.919, Breslow p = 0.834, Tarone-Ware p = 0.880) in the Kaplan-Meier Survival analysis.

Conclusion: We observed that tricuspidal valve repair does not represent survival benefit over tricuspidal valve replacement.