PMID- 24477739 OWN - NLM STAT- MEDLINE DCOM- 20150622 LR - 20141002 IS - 1873-734X (Electronic) IS - 1010-7940 (Linking) VI - 46 IP - 4 DP - 2014 Oct TI - Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery. PG - 713-9; discussion 719 LID - 10.1093/ejcts/ezt638 [doi] AB - OBJECTIVES: To assess long-term outcomes of tricuspid valve replacement (TVR) after previous left-side heart surgery. METHODS: We reviewed reoperative TVR after left-side heart surgery performed at our institution between March 1997 and June 2012. In-hospital data were retrieved from our institutional database or medical records; follow-up was performed through telephone call, surviving patients being asked to provide a recent (2 in 79.5% of patients, right ventricle (RV) dysfunction >mild in 23.9% of patients and mean systolic pulmonary artery pressure (sPAP) 48.4 mmHg. A mechanical prosthesis was implanted in 5.1% of patients. A right thoracotomy was preferred to median sternotomy in 8.6% of cases. Isolated-TVR (I-TVR) was performed in 52.1% of patients, a beating-heart approach being used in 85.2% of I-TVR cases. Postoperative RV failure occurred in 46.1% of patients. Median length-of-stay was 11.5 days. Thirty-day mortality was 6.0% overall and 8.2% in the I-TVR group. Higher preoperative LES (P = 0.002), ascites (P = 0.004), RV dysfunction (P = 0.033) and sPAP (P = 0.046) were associated with acute mortality. No significant difference in acute outcomes was observed between beating and arrested-heart I-TVR, except for postoperative median length-of-stay (9 vs 28 days, respectively, P = 0.007). Among survivors median follow-up time was 5.1 years. Five-year and 10-year freedom from cardiac death were 79.4 and 61.0%, freedom from tricuspid reoperation were 97.3 and 87.5%, freedom from bioprosthesis degeneration were 92.8 and 74.3%, respectively. Five-year and 10-year survival in the I-TVR subgroup were respectively 74.4 and 61.6%. Higher preoperative sPAP was associated with increased follow-up mortality (P = 0.048). At the last follow-up, NYHA class I-II was found in 86.1% of surviving patients. CONCLUSIONS: In selected cases, TVR is currently feasible with low acute mortality, especially if performed in the absence of ascites, significant RV dysfunction and pulmonary hypertension. Long-term mortality remains more difficult to predict, although it appeared to be also associated with higher preoperative pulmonary pressure. The global high-complexity profile of these patients is likely to impair long-term outcomes. CI - (c) The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. FAU - Buzzatti, Nicola AU - Buzzatti N AD - Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy buzzatti.nicola@hsr.it. FAU - Iaci, Giuseppe AU - Iaci G AD - Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. FAU - Taramasso, Maurizio AU - Taramasso M AD - Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. FAU - Nisi, Teodora AU - Nisi T AD - Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. FAU - Lapenna, Elisabetta AU - Lapenna E AD - Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. FAU - De Bonis, Michele AU - De Bonis M AD - Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. FAU - Maisano, Francesco AU - Maisano F AD - Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. FAU - Alfieri, Ottavio AU - Alfieri O AD - Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy. LA - eng PT - Journal Article DEP - 20140128 PL - Germany TA - Eur J Cardiothorac Surg JT - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JID - 8804069 SB - IM MH - Aged MH - Female MH - Heart Valve Prosthesis Implantation/*adverse effects/*methods MH - Heart Ventricles/surgery MH - Humans MH - Kaplan-Meier Estimate MH - Male MH - Middle Aged MH - Postoperative Complications MH - Reoperation/adverse effects/methods MH - Treatment Outcome MH - Tricuspid Valve/*surgery OTO - NOTNLM OT - Left side OT - Reoperative OT - Replacement OT - Right ventricle OT - Tricuspid EDAT- 2014/01/31 06:00 MHDA- 2015/06/24 06:00 CRDT- 2014/01/31 06:00 PHST- 2014/01/31 06:00 [entrez] PHST- 2014/01/31 06:00 [pubmed] PHST- 2015/06/24 06:00 [medline] AID - ezt638 [pii] AID - 10.1093/ejcts/ezt638 [doi] PST - ppublish SO - Eur J Cardiothorac Surg. 2014 Oct;46(4):713-9; discussion 719. doi: 10.1093/ejcts/ezt638. Epub 2014 Jan 28.