Surgical risk and outcome of repair versus replacement for late tricuspid regurgitation in redo operation

Abstract

Background: Late tricuspid regurgitation after previous cardiac operation remains controversial in terms of when to repair and who will benefit. We reviewed our surgical experiences and stratified the risk factors for death and morbidity.

Methods: From September 2005 to September 2010, 77 consecutive patients (36 men [47%]) underwent redo open heart operations with the tricuspid valve (TV) procedure. Their mean age was 56±13 years (range, 27 to 83 years). TV repair was performed in 44 (57%) and TV replacement in 33 (43%): 23 received bioprostheses; 10 received mechanical prostheses.

Results: Fourteen (18%) patients died after the operation. Risk factors of hospital death by multivariate analysis were age (>65 years), preoperative renal insufficiency (creatinine>2 mg/dL), and preoperative severe liver cirrhosis (Child classification C). Compared with the group that underwent TV repair, those who underwent TV replacement tended to have had previous TV operations (46% vs 9%; p<0.001) and preoperative Child class C liver cirrhosis (21% vs 2%; p=0.018). Although in-hospital mortality was insignificant (24% vs 14%; p=0.232), postoperative morbidities of tracheotomy, gastrointestinal bleeding, and late death were higher in the replacement group.

Conclusions: Patients who had previous TV operations and preoperative severe liver cirrhosis were more likely to undergo TV replacement in tricuspid reoperations. Compared with patients in the repair group, patients in the replacement group had higher morbidities and low late survival. Earlier intervention, before decompensated heart failure occurs, is warranted to improve the outcome.