The outcome of patients undergoing simultaneous tricuspid and left-sided valve surgery in a rheumatic population.

Abstract

Background In the context of endemic left-sided rheumatic heart disease, tricuspid valve disease requiring surgical intervention merits closer scrutiny in order to analyse surgical outcomes with presently employed techniques. Aims To evaluate the results of simultaneous tricuspid valve surgery for severe functional tricuspid regurgitation in rheumatic heart disease at the time of left-sided valve surgery. Materials and methods A retrospective analysis of the perioperative and follow-up data of 30 patients who underwent tricuspid valve surgery with concomitant mitral and/or aortic valve replacement between July 2003 and December 2011 was undertaken. Patients referred for left-sided valve replacement surgery with clinically and echocardiographically documented severe functional tricuspid regurgitation in the presence of tricuspid annular dilatation, were submitted for combined valvular procedures. Outcomes were analysed by evaluation of the perioperative and 2-year follow-up clinical and echocardiographic data. Results There was a statistically significant improvement in the following parameters at 6 weeks postoperatively: New York Heart Association functional class, tricuspid annular diameter (p 0.001), pulmonary artery systolic pressure (p 0.001), severity of tricuspid regurgitation (p<0.001) and tricuspid transvalvular gradient (p 0.004). Preoperative (p 0.013) and postoperative pulmonary hypertension (p<0.002) were demonstrated to be associated with the development of major adverse cardiovascular events. There were no identifiable predictors for the development of severe residual postoperative tricuspid regurgitation. The development of severe residual postoperative tricuspid regurgitation was not associated with the occurrence of major adverse cardiovascular events. The technique of tricuspid valve repair did not impact on the occurrence of major adverse cardiovascular events or on the development of severe residual postoperative tricuspid regurgitation. A satisfactory outcome was observed in 40% of the study population. Conclusion The immediate results of tricuspid valve surgery for severe functional tricuspid regurgitation in rheumatic heart disease favour surgical intervention. However, the persistence of severe tricuspid regurgitation adversely influenced long-term outcomes. Therefore, the management of rheumatic patients with functional tricuspid regurgitation should encompass surgical strategies which result in a lower incidence of severe residual postoperative tricuspid regurgitation.