Repair or Replacement for Isolated Tricuspid Valve Pathology? Insights from a Surgical Analysis on Long-Term Survival
Mina Farag, Rawa Arif, Anton Sabashnikov, Mohamed Zeriouh, Aron-Frederik Popov, Arjang Ruhparwar, Bastian Schmack, Pascal M. Dohmen, Gábor Szabó, Matthias Karck, Alexander Weymann
Department of Cardiac Surgery, Heart and Marfan Center – University of Heidelberg, Heidelberg, Germany
Med Sci Monit 2017; 23:1017-1025
Long-term follow-up data concerning isolated tricuspid valve pathology after replacement or reconstruction is limited. Current American Heart Association guidelines equally recommend repair and replacement when surgical intervention is indicated. Our aim was to investigate and compare operative mortality and long-term survival in patients undergoing isolated tricuspid valve repair surgery versus replacement.
MATERIAL AND METHODS: Between 1995 and 2011, 109 consecutive patients underwent surgical correction of tricuspid valve pathology at our institution for varying structural pathologies. A total of 41 (37.6%) patients underwent tricuspid annuloplasty/repair (TAP) with or without ring implantation, while 68 (62.3%) patients received tricuspid valve replacement (TVR) of whom 36 (53%) were mechanical and 32 (47%) were biological prostheses.
RESULTS: Early survival at 30 days after surgery was 97.6% in the TAP group and 91.1% in the TVR group. After 6 months, 89.1% in the TAP group and 87.8% in the TVR group were alive. In terms of long-term survival, there was no further mortality observed after one year post surgery in both groups (Log Rank p=0.919, Breslow p=0.834, Tarone-Ware p=0.880) in the Kaplan-Meier Survival analysis. The 1-, 5-, and 8-year survival rates were 85.8% for TAP and 87.8% for TVR group.
CONCLUSIONS: Surgical repair of the tricuspid valve does not show survival benefit when compared to replacement. Hence valve replacement should be considered generously in patients with reasonable suspicion that regurgitation after repair will reoccur.
Keywords: Cardiac Valve Annuloplasty, Tricuspid Valve, Tricuspid Valve Insufficiency