The risk and outcomes of reoperative tricuspid valve surgery.

Background: Outcomes after tricuspid valve reoperation have not been published before. This study examines our 32-year experience in this cohort of patients.

Methods: Between May 1979 and January 2011, a total of 68 patients who had previous tricuspid valve surgery (49 repairs and 19 replacements) had reoperations on their tricuspid valves. The median age was 60 years (19 to 75). Redo tricuspid valve pathologies included 18 functional and 50 organic. Follow-up was 100% complete, with a mean follow-up of 87 months (5 to 248).

Results: Re-repair of the tricuspid valve was feasible in 26 patients (16 of 18 [89%] functional and 10 of 31 [32%] organic, p < 0.001). In-hospital mortality was 13.2%. Factors related to early mortality were nonelective surgery, New York Heart Association (NYHA) functional class III/IV, left ventricle ejection fraction less than 0.40, cardiopulmonary bypass time greater than 136 minutes, and postoperative low cardiac output syndrome (p < 0.05). Postoperative complications included 9 reoperations for bleeding, 11 postoperative low cardiac output syndrome, 5 renal failure requiring dialysis, 3 strokes, and 13 pacemaker implantation. Factors related to late mortality were age greater than 60 years, male sex, ventilation time greater than 24 hours, cardiopulmonary bypass time greater than 136 minutes, and postoperative low cardiac output syndrome (p < 0.05). Survivors had 5-, 10-, and 15-year survival rates of 86%, 64%, and 33%, respectively. Functional class improved in hospital survivors; NYHA class I/II 80.6% compared with preoperative NYHA class III/IV of 90% (p = 0.001).

Conclusions: Redo tricuspid valve surgery is associated with high operative mortality and morbidity; however, survivors benefited from reasonable survival rates. Re-repair of the tricuspid valve is feasible in the majority of patients with functional tricuspid valve pathology, while the majority of patients with underlying organic pathology required a valve replacement.