[Effect of surgical treatment of tricuspid regurgitation late after valve replacement of left heart].

Objective: To investigate the appropriate methodology and outcome of surgical treatment of tricuspid regurgitation late after valve replacement of left heart.

Methods: Eighteen patients with tricuspid insufficiency, with the diagnosis conformed by echocardiogram and in New York Heart Association (NYHA) class III to IV, were treated surgically 3 to 14 years after left heart valve replacement, including 13 mitral valve replacements and 5 double valve replacements, from January 1995 to May 2004. DeVega was used in 5 patients. The ages at the time of tricuspid surgery ranged from 35 to 65 years (median 50 years). The patients were followed up for 36.7 months (12-114 months).

Results: There was no death from hemorrhage because of re-open. Tricuspid repair was performed in 8 patients, tricuspid replacement was done in 10 patients, 5 bioprostheses and 5 mechanical valves were implanted. The hospital mortality was 16.7%. Among the survivors, the three-year survival rate was 78.8%. Twelve patients showed improvement of symptoms, while there was no improvement in 3 patients who needed medical therapy.

Conclusion: The pathophysiology of tricuspid regurgitation is associated with delayed left heart operation, implement of tricuspid repair in the first operation or progressive right ventricular failure. The surgical intervention should be earlier before the onset of severe right ventricular failure Tricuspid valve repair is the procedure of choice, while tricuspid valve replacement is also acceptable.