Results and factors associated with adverse outcome after tricuspid valve replacement.

BACKGROUND AND AIM: This retrospective analysis of patients with severe tricuspid valve disease, who underwent tricuspid valve replacement (TVR) for either tricuspid regurgitation or stenosis, has been designed to determine the factors that predict poor hospital and long-term survival. METHODS: The study population comprised 86 patients, 65 women and 21 men, who underwent TVR with or without con-comitant surgical procedures between 2000 and 2010 at our institution. Patients with Ebstein's or other complex congenital anomalies were excluded from the study. RESULTS: Average age at operation was 58.5 ± 12.5 (range 16-78) years. Fifty (58.1%) patients had undergone previous cardiac surgery. Forty-two patients were in New York Heart Association (NYHA) class III functional capacity, and 18 were in class IV. Symptoms of right heart failure (HF) were present in 66 patients, of whom 19 had ascites. Bioprosthetic tricuspid valves were implanted in 84 patients and mechanical prostheses in two. The choice to proceed to TVR instead of repair was individualised and based on the surgeon's preference. In-hospital mortality was 18 (20.9%) patients, caused mainly by multi-organ and HF, and was significantly related to NYHA class and symptoms of right HF before surgery, with no mortality in patients with NYHA class I and II, 19% mortality with NYHA class III, and 55.6% mortality with NYHA class IV. Eighteen (20.9%) patients died during postoperative follow-up. The main risk factors associated with perioperative mortality were: the presence of severe symptoms at the time of surgery, low preoperative haematocrit, postoperative complications, postoperative ventilation time longer than 72 h, and renal failure requiring dialysis. Elevated pulmonary artery pressure, preoperative symptoms of right HF, and low haematocrit unfavourably affected the long-term results. CONCLUSIONS: Many earlier studies reported high mortality and morbidity after TVR in both early and late postoperative peri-ods. Our main finding is that good outcomes for TVR are achievable in properly selected patients. Sixty of 86 patients in our group had preoperative NYHA functional class III and IV, which suggests that surgical timing was late in many patients. Based on our observations, we propose that surgical correction of severe tricuspid valve disease should be considered before the development of advanced HF, when patients are asymptomatic or only oligosymptomatic.

[Early and mid-term evaluation of the pulmonary autograft function in adolescents and adults]. / Ocena wczesna i srednioodlegla funkcji autograftu plucnego u mlodziezy i doroslych.

The aim of this study was to establish the indications to use of pulmonary autograft in the treatment of aortic valve disease in the adolescents and adults; early and mid-term an evaluation of autograft's function and function of left ventricle after Ross operation. In this procedure the patient's own pulmonary valve is removed together with the main trunk of the pulmonary artery and used to replace the aortic valve. Pulmonary homograft is used to reconstruction of right ventricular outflow tract. Between February 1994 and march 2001 in 1st Cardiac Surgery Department in 43 patients over 14 years of age Ross operation have performed. Mean age was 24.9 years. Indications for operation were predominant aortic stenosis in 29 patients, aortic incompetence in 7 patients, and complex aortic valve disease in 7 patients. Hospital mortality was 4.6%. In mid-term observation 41 patients left. All survivors remained in New York Heart Association functional class I and were free of complications and medications. In the all patients autograft's valve have functioned excellent (without or small regurgitation). Echocardiographic parameters of left ventricular function improved in the all patients. The indications to pulmonary autograft insertion in the adolescents and adults are small aortic ring, infective endocarditis and contraindications to anticoagulants using. The early and mid-term results confirm a high efficacy Ross operation in this age's group with low mortality. It completely relieves the abnormal loading conditions of the left ventricle, resulting in a complete recovery of left ventricular function.