OBJECTIVETo summarize the experience in tricuspid valve replacement (TVR).

METHODSFrom March 1997 to June 2004, 42 patients underwent isolated or combined TVR. Of the cases, 20 cases had prior cardiac operation (tricuspid valve had been repaired in 8). Indication of TVR: (1) irreparable and/or progressive tricuspid lesions; (2) intolerable tricuspid dysfunction after tricuspid repair. Instead of tricuspid repair, TVR was preferred when one of the following co-existed: moderate to severe increase of pulmonary vascular resistance; residual left heart dysfunction; previously repaired tricuspid. Simultaneous replacement after unsuccessful tricuspid repair had to be done in 14 cases. Valve replacement combinations were isolated TVR in 30 cases, tricuspid and aortic and mitral in 8, tricuspid and mitral in 3, tricuspid and aortic in 1. Fourteen tissue and 28 bi-leaflet mechanical valve prostheses were used in the tricuspid position. Other simultaneous procedures included corrections of congenital anomalies in 10 patients, repair of peri-prosthetic leakage, resection of myxoma and coronary artery bypass grafting in 1 case each.

RESULTSThe operative mortality was 17%, and mortality 31%. Four patients died of low cardiac output. Massive cerebral thromboembolism, renal failure and dyscrasia was the cause of death in 1 case each. Post-operative heart function NYHA classification: 21 cases in I, 10 in II, 1 in III and 1 in IV. Late death occurred in 2 cases.

CONCLUSIONSTVR is preferable for a severely damaged or deformed tricuspid valve if the possibility of successful repairing is small, especially when accompanied pulmonary vascular disease and uncorrected lesions and/or dysfunction of the left heart co-exists.