Isolated Tricuspid Valve Surgery: Repair Versus Replacement.

INTRODUCTION: Isolated tricuspid valve surgery (ITVS) is an uncommon procedure with few studies published. We report our series of ITVS and compare surgical outcomes and mortality in patients undergoing valve repair (TVR) versus replacement (TVRep).

METHODS: Retrospective study including all patients who underwent ITVS (n = 34) between July 2008 and June 2017, divided in two groups according to type of procedure: TVR 20 patients and TVRep 14 patients. We reviewed preoperative characteristics and analysed operative data, outcomes and mortality in both groups.

RESULTS: Thirty-four patients underwent ITVS, mean age 58,1±15,9 years, 50% female and mean BMI 26,1kg/ m2. TVR was performed in 58,8% and TVRep in 41,2% of patients. Patients had similar demographic and baseline characteristics, except for previous cardiac surgery (TVRep 78,6% vs.TVR 35,%, p<0,05). Mean logistic EuroSCORE was 10,1% for TVRep and 6,6% for TVR (p<0,05). Etiologies were functional insufficiency (68%), endocarditis (18%), degenerative (9%), rheumatic (3%) and congenital (3%). TVR was the preferred surgical approach. Ring annuloplasty was performed for all TVR and bioprosthesis was used for all TVRep. Postoperative complications were: need for transfusional support (76,5%), inotropic support longer than 48 hours (38,2%), prolonged invasive ventilation over 24 hours (35,3%), new onset of atrial fibrillation (11,8%), duplication or postoperative creatinine over 2 mg/dl (8,8%), dialysis (8,8%), stroke (5,9%), intra-aortic balloon pump (5,9%), permanent pacemaker implantation (2,9%) and sepsis (2,9%). TVRep was associated with superior length of surgery (TVRep 291 vs. TVR 186 minutes), longer ICU stay (TVRep 17,1 vs.TVR 2,8 days), longer hospital stay (TVRep 37,1 vs.TVR 11,7 days), prolonged invasive ventilation (TVRep 71,4% vs.TVR 10%) and longer inotropic support (TVRep 78,6% vs.TVR 10%) (p<0,05). Overall 30-day and 1-year mortality were 8,8% and 17,6%, respectively. Type of procedure was not associated to 30-day mortality (TVRep 14,3% vs. TVR 5%, p<0,05), but TVRep was associated with higher 1-year mortality (TVRep 35,7% vs. TVR 5%, p<0,05).

CONCLUSIONS: TVR showed better outcomes, with less postoperative complications and mortality than TVRep. This difference cannot be linked to type of pathology, although patients in the latter group may be associated to greater complexity, with higher risk and were often reoperations.