Tricuspid Valve Replacement: The Effect of Gender on Operative Results
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Dror Ben Leviner1, Benjamin Medalion1, Inbal Baruch1, Alex Sagie2, Erez Sharoni1, Avi Fuks1, Dan Aravot1, Ram Sharony1 Departments of 1Cardiothoracic Surgery and 2Cardiology, Rabin Medical Center, Petach Tiqva, Israel |
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Background and aim of the study: Tricuspid valve replacement (TVR) is considered a high-risk operation. The study aim was to analyze the authors’ eight-year experience with TVR and to characterize the specific risk factors for this operation. Methods: Between January 2005 and August 2012, a total of 67 patients (46 females, 21 males; mean age 58 ± 14 years; range: 25-86 years) underwent TVR at the authors’ center. Re-do operations were performed in 48 patients (72%), including 37 patients (55%) who had at least two previous surgeries. Isolated TVR was performed in 28 patients (42%). The follow up (mean 28 months) included echocardiography and survival analysis. Results: The overall operative mortality was 17.9% (n = 12, all female). In the latter half of the study period, mortality declined to 11.4% (p = NS). Major postoperative morbidity included prolonged mechanical ventilation (28.4%), low cardiac output (29.8%), and acute renal failure requiring hemodialysis (10.4%). Univariate analysis revealed that female gender (p = 0.007), NYHA class (p = 0.038), serum bilirubin level (p = 0.02) and number of |
previous cardiac surgeries (p = 0.05) were associated with increased operative mortality. Multivariable analysis demonstrated that reoperation (OR 6.06, p = 0.036) was an independent risk factor for operative mortality or complications. Echocardiography at follow up showed that 92.6% of all patients had tricuspid regurgitation grade <2. The overall five-year survival rates for males and females were 82% and 53%, respectively (p = 0.03), but five-year survival for operative survivors was similar in males and females (82% versus 73%, p = 0.5). Cox regression analysis showed that age (OR 1.07, p = 0.028) and reoperation (OR 6.1, p = 0.038) were independent risk factors for late mortality. Conclusion: TVR remains a high-risk operation, particularly for advanced age and previously operated patients; however, the long-term survival is satisfactory. Typically, women undergo TVR at an older age with a higher mortality rate than men. However, the long-term mortality rate of patients who survived surgery was not associated with gender. The Journal of Heart Valve Disease 2014;23:209-215 |
| Tricuspid Valve Replacement: The Effect of Gender on Operative Results | |
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