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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 124-133, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LB McGrath, L Gonzalez-Lavin, BM Bailey, GL Grunkemeier, J Fernandez and GW Laub
From Jan. 1, 1961, through Dec. 31, 1987, 530 patients underwent an
intracardiac operation that included a tricuspid valve procedure. The
tricuspid valve was repaired in 351 patients (66%) and replaced in 179
(34%). Mean age was 56.9 years. Risk factors associated with tricuspid
valve replacement included tricuspid stenosis (p = 0.02), jugular venous
distention (p = 0.04), previous operation (p = 0.05), and angiographic
severity of tricuspid valve incompetence (p less than 0.001). There were 78
hospital deaths (15%). Risk factors for hospital death included previous
operation (p = 0.03), male gender (p = 0.03), hepatomegaly (p = 0.03), De
Vega or Carpentier annuloplasty (repair group only), (p = 0.01), and older
age at operation (p = 0.06). Ninety- eight percent of the patients were
followed up. There were 185 late deaths (41%). The actuarial survival rate
was 20% at 180 months. Risk factors for late death included male gender (p
= 0.03), hepatomegaly (p = 0.04), and lack of postoperative warfarin
therapy (p less than 0.001). Actuarial freedom from reoperation was 25.5%
at 180 months. There was no difference in reoperation rates (p = 0.10) or
survival (p = 0.42) whether the tricuspid valve had been repaired or
replaced. We conclude that the requirement for surgical treatment of
tricuspid valve insufficiency in patients with multivalvular disease
constitutes a high risk group for cardiac surgery. Preoperative variables
may predict the result of tricuspid valve replacement. Tricuspid valve
replacement may be performed with the expectation of a low risk of
valve-related events.
ARTICLES
Tricuspid valve operations in 530 patients. Twenty-five-year assessment of early and late phase events
Department of Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015.
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