Combined triple valve surgery carries a significant operative mortality but offers reasonable long-term survival and symptom relief, heavily dependent on preoperative functional status.
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NYHA class informs risk assessment for triple valve surgery; supports stratification but leaves open prospective validation.
Between 1968 and 1984, 78 patients (mean age 43, range 14 to 65 years) underwent combined aortic, mitral and tricuspid surgery (22 triple valve replacements, 56 aortic valve replacements with tricuspid conservative surgery and mitral valve replacement (N = 48), or commissuroplasty (N = 8). Pre-operative consequences of valvular disease (mainly mixed valve disease) were severe as assessed by functional class (72 pts in III or IV NYHA), cardiomegaly (CTR: 62 +/- 6%), increase of mean pulmonary arterial and wedge pressures (respectively 30 +/- 12 and 19 +/- 6 mmHg) decrease in cardiac index (2.1 +/- 0.5 l min-1 m-2), LV dilatation (LV end diastolic volume: 184 +/- 86 ml m-2) and impairment of LV systolic function (LV ejection fraction: 50 +/- 12%). Operative mortality rate was 11.5%. The 69 survivors were all followed up, for a mean of 56 months (2 to 207). 16 late deaths occurred. Actuarial survival rate at 10 years was 58.4%, and greatly influenced by pre-operative NYHA class. Linearized rates of thromboembolic events, valve thrombosis and haemorrhage were respectively 6.4, 1.5 and 1.2% pt-1 yr-1. Those of infective endocarditis, periprosthetic leak, reoperation and valve failure were 0.6, 3.3 and 4.9% pt-1 yr-1 respectively. At 9 years, 42% of the patients were in NYHA class I or II and free from complications.
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Michel et al. (1987) studied this question.
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