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Isolated Tricuspid valve surgery - Early and late outcome
Dan Spiegelstein, Hillit Cohen, Ido Ferstenfeld, Shani Levin, Leonid Sternik, Alexander Kogan, Ori Vatury, Rafael Kuperstein, Ehud Raanani.
Chaim Sheba Medical Center, Ramat Gan, Israel.

Primary Tricuspid valve (TV) surgery is rare, as it is usually performed as a concomitant reconstruction procedure in addition to the correction of other cardiac pathologies, mainly mitral-valve surgery. The outcome for TV surgery as the primary indication is still unclear. We describe our experience of TV surgery, as TV pathology was the primary indication for surgery.
From 2004 until 2013 we performed 569 TV surgeries. From this group we identified 55 patients, with TV pathology as the primary indication for surgery. Mean age was 61±14 and 27% were males. TV pathology included RHD in 16 patients (29%), secondary in 23(42%), endocarditis in 5(9%), prosthetic dysfunction in 5(9%), and other in 6 patients (11%). Isolated TV was done in 49 patients (89%) and there were 6 concomitant procedures: 4 CABG; 1 pacemaker and 1 PFO. From those 55 patients 18 underwent TV-repair (33%) and 37 TVR (67%). There were 70% redo operations.
Overall in-hospital mortality was 9% (5 patients). Major complications included re-open for bleeding/tamponada 5(9%), prolonged ventilation (>48h) 13(24%), respiratory failure and tracheostomy 3(5%), renal failure 7(13%), dialysis 10(18%), new pacemaker 3(6%), deep sternal wound infection 2(4%), and sepsis 8(15%). Mean hospital length of stay, ICU and ventilation times were 17±18, 7.8±14 and 2.2±3.5 days, respectively. Multi-variant analysis for predictors of early mortality and major complication were NYHA FC IV & female gender. During follow-up of 33±26 months, there were 12 late mortality (24%). Actuarial survival at 1, 2, 3 and 5 years were 78%, 73%, 71% and 66%, respectively.
Patients who require TV surgery constitute a high-risk group. There were no statistical differences in early and late outcomes between the isolated TV repairs versus replacement. Timely referral to surgery before the onset of class IV heart failure is recommended for improved outcome.:

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