Reoperation for Isolated Rheumatic Tricuspid Regurgitation

Moutakiallah Younes, Aithoussa Mahdi, Atmani Noureddine, Seghrouchni Aniss, Moujahid Azeddine, Mounir Reda, Hatim G. Abdedaim, Asfalou Ilyasse, Boulahya Abdelatif

Mohammed V Military Hospital - Faculty of Medicine and Pharmacy of Rabat - Mohammed V University, Rabat, Morocco

Date, time and location: 2018.05.25 10:30, Exhibition area, 1st Floor. Zone – D

Abstract

Objective: The reoperation of isolated tricuspid regurgitation in rheumatic population is rare and still unclear and controversial because of the rarity of publications. The aim of this study was to analyze short- and long-term results and outcome of tricuspid valve surgery after left-sided valve surgery in rheumatic patients.

Methods: Twenty six consecutive rheumatic patients who underwent isolated tricuspid valve surgery after left-sided valve surgery between January 2000 and January2017 were enrolled in the study. The mean age was 48.2±8.6 years with 8.3% as sex-ratio (M/F). EuroSCORE was 6.1±5 (2.5-24.1). The mechanism of tricuspid regurgitation was functional and organic in respectively 14 (53.8%) and 12 cases (46.2%). Ten patients (38.5%) had previous tricuspid valve repair. Surgery consisted of 15 ring annuloplasty and 11 tricuspid valve replacement (5 bioprostheses and 6 mechanical prostheses). Follow-up was 96.1% complete, with a mean follow-up of 55.6±38.8 months (1-165 months).

Results: The operative mortality rate was 15.4% (n=4) and the cumulative survival at 1, 5 and 10 years was respectively 80±8%, 71±9% and 59±13%. The actuarial survival was 115.5±14.4 months (84.3-153.7 months) with no significant difference between tricuspid valve replacement (81.7±12.8 months) and repair (109.8±19.5 months) (p=0.75). Multivariable Cox regression analysis revealed that ascitis (HR, 5.8; p=0.01), and right ventricular dysfunction (HR, 9.4; p=0.001) were predictors of major adverse cardiac events. There were no recurrence of tricuspid regurgitation and no structural or non-structural deterioration of valvular prosthesis.

Conclusion: The reoperation of rheumatic tricuspid regurgitation should be considered before the installation of complications such right ventricular dysfunction and major signs of right heart failure. Despite the superiority of repair techniques, tricuspid valve replacement should not be banished.