Tricuspid valve replacement for acquired isolated tricuspid valve disease - operative and mid-term results

Isolated tricuspid valve replacement for acquired tricuspid valve disease is rare. We studied the etiologies leading to tricuspid valve replacement, the preoperative conditions and the postoperative outcome of patients who underwent isolated tricuspid valve replacement at our institution. From the clinical database we identified all patients (n=126) who underwent tricuspid valve replacement between 01 January 1985 and 31 July 2003. We encountered 28 consecutive patients (16 female, mean age 53.6 years) who underwent 30 isolated tricuspid valve replacements for acquired tricuspid valve insufficiency. The mean follow-up time for these patients averaged 38 (1-221) months. Tricuspid valve regurgitation was caused in 3 patients by infective, in 6 patients by healed endocarditis, 1 patient suffered from healed perimyocarditis, 2 from hypertrophic non-obstructive cardiomyopathy and 1 from endomyocardial fibrosis. In one patient the tricuspid insufficiency was related to constrictive pericarditis and in 4 patients to prior heart transplantation. Two patients underwent previous tricuspid valve replacement and one tricuspid valve resection in other institutions. Twenty patients received mechanical valves, 10 bioprostheses. One patient died perioperatively (3.6%), 6 during the follow-up time (21%). Two patients underwent a redo-operation, one due to prosthetic endocarditis of a biological prosthesis, the other after thrombosis of a mechanical prosthesis. No structural deterioration of biological prostheses, no bleeding due to anticoagulation with mechanical prostheses occurred. Of the surviving patients 18 were in New York Heart Association functional class I, two in class II and one in II-III at the time of the follow-up. Isolated tricuspid valve replacement for acquired tricuspid valve insufficiency is rarely performed and due to a multitude of different etiologies. Perioperative mortality and morbidity and prosthesis related complications are comparatively lower than previously reported. The mid-term results are largely dependent on the etiology of the regurgitation and the patients' comorbidity.