Key result
TVR linked to ~36% early mortality, driven by preoperative pulmonary and hepatic dysfunction.
Why the study?
The study examined factors influencing early and late mortality in patients undergoing tricuspid valve replacement.
What factors influence early and late mortality in patients undergoing primary or secondary tricuspid valve replacement?
Cohort (n=74)
What factors influence early and late mortality in patients undergoing primary or secondary tricuspid valve replacement?
Answers are grounded in this paper and cite their sources.
Tricuspid valve replacement in predominantly NYHA III-IV patients carries high early mortality (~35-37%), driven by impaired preoperative pulmonary and hepatic function,though cardioplegic protection has significantly reduced early mortality.
Seventy four patients underwent tricuspid valve replacement (TVR), between 1968 and 1983. 93% were female, mean age was 44 +/- 4 years. Tricuspid valve was replaced with a mechanical prosthesis in 52 and a bioprosthesis in 22 patients. Fifty seven patients underwent primary TVR and 17 underwent a secondary TVR following a mean interval of 41 +/- 2 months (SEM) following a previous mitral or tricuspid valve operation. Preoperatively 86% patients were in NYHA class III-IV and congestive cardiac failure (CHF). Early mortality for primary TVR was 36.8% and 35.2% for secondary TVR. Early mortality has been significantly reduced since the introduction of cardioplegic protection for the associated valve lesions. Early mortality was significantly influenced by the reduced preoperative values of FVC and FEV1 in patients with long standing mitral valve disease and by raised preoperative levels of plasma bilirubin and alkaline phosphate in patients with CHF. Risk of thrombotic occlusion and late deaths remained high during the first year after TVR with a mechanical prosthesis.
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Kaul et al. (1990) conducted a cohort in Tricuspid valve disease requiring tricuspid valve replacement (n=74). Tricuspid valve replacement (mechanical prosthesis in 52, bioprosthesis in 22; primary in 57, secondary in 17) vs. Secondary tricuspid valve replacement (n=17) vs primary tricuspid valve replacement (n=57) was evaluated on Early mortality. Tricuspid valve replacement carried an early mortality of 36.8% for primary procedures and 35.2% for secondary procedures, influenced by poor preoperative pulmonary and hepatic function.
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