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The Journal of Cardiovascular Surgery 2001 August;42(4):443-9

language: English

Tricuspid valve involvement in combined mitral and aortic valve surgery

Mueller X. M., Tevaearai H. T., Stumpe F., Fischer A. P., Hurni M., Ruchat P., von Segesser L. K.

From ­the Clinic ­for Cardiovascular Surgery CHUV (Centre Hospitalier Universitaire Vaudois) Lausanne, Switzerland


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Background. Combined ­mitral ­and aor­tic ­valve dis­ease requir­ing sur­gery ­may ­involve ­the tri­cus­pid ­valve as ­well. Our treat­ment pol­i­cy is con­ser­va­tive espe­cial­ly ­for tri­cus­pid regur­gi­ta­tion ­which is oper­at­ed on ­when ­severe ­only.
Methods. A ret­ro­spec­tive ­study ­was per­formed at a ter­tiary ­and sec­on­dary refer­ral cen­ter ­for car­di­o­vas­cu­lar dis­ease. Over a 15-­year peri­od, 65 con­sec­u­tive ­patients under­went aor­tic ­and ­mitral sur­gery ­with con­com­i­tant tri­cus­pid regur­gi­ta­tion ­and/or sten­o­sis. Fifty-five/65 (85%) ­patients ­were in ­NYHA ­class ­III-IV. Fifty-eight/65 (89%) ­patients ­had tri­cus­pid regur­gi­ta­tion sec­on­dary to ­right cham­ber dil­a­ta­tion ­and 7/65 (11%) ­had tri­cus­pid sten­o­sis ­and/or regur­gi­ta­tion ­because of pre­vi­ous endo­car­ditis. Twenty-two/65 (34%) tri­cus­pid ­valves ­were oper­at­ed on: 18/22 (82%) de Vega annu­lo­plas­ty, 2/22 (9%) com­mis­su­rot­o­mies ­and 2/22 (9%) pros­thet­ic ­valves. Mortality ­and com­pli­ca­tions ­were record­ed dur­ing a ­mean fol­low-up of 5.3 ­yrs (­range, 6 ­months-15.3 ­yrs). Event-­free sur­vi­vals ­were deter­mined ­using ­the Kaplan-Meier meth­od.
Results. Hospital mor­tal­ity ­was 6.2% (4/65) ­and ­the com­pli­ca­tion ­rate ­was 18.5% (12/65). The free­dom ­from ­late ­valve relat­ed mor­tal­ity ­and mor­bid­ity at 5, 10 ­and 15 ­years ­was 86±5.5%, 81.9±6.8%, ­and 81.9±6.8% respec­tive­ly. One ­valve relat­ed com­pli­ca­tion ­was ­due to ­the tri­cus­pid ­valve. At ­last fol­low-up, 87% (47/54) of ­the sur­vi­vors ­were in ­NYHA ­class I-II.
Conclusions. With a con­ser­va­tive pol­i­cy of tri­cus­pid ­valve inter­ven­tion, func­tion­al ­results of ­this ­patient pop­u­la­tion are ­good ­and ­long-­term ­valve relat­ed mor­bid­ity ­and mor­tal­ity ­are main­ly relat­ed to ­the ­mitral ­and aor­tic ­valve pro­ce­dures.

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