Objective: To compare the efficacies of tricuspid valve replacement versus plasty for moderate-to-severe tricuspid regurgitation with right heart failure.
Methods: From January 2003 to June 2008, a total of 228 patients with right heart failure undergoing tricuspid valve operations were selected. And the procedures included tricuspid valve plasty (n=127) and tricuspid valve replacement (n=101). During a follow-up period of 65 months, their perioperative data were collected to evaluate the surgical outcomes.
Results: The abnormal liver function rate and average pulmonary artery systolic pressure in tricuspid valve plasty group were lower than those in tricuspid valve replacement group (P=0.023, 0.033). In replacement group, average aortic cross-clamping time, cardiopulmonary bypass time, ventilation time and stay length of intensive care unit (ICU), the usage of inotropic drug was significantly higher than repair group (P<0.01). The early complication rate (15.8%) and case fatality rate (6.3%) of repair group were much lower than those of replacement group (27.3%, 16.8%) (P=0.042, 0.011). Long-term follow-ups revealed that the tricuspid valve thrombosis rate in replacement group was higher than that in repair group (P=0.036). And the recurrence rate of moderate-to-severe tricuspid regurgitation in repair group was higher than that in replacement group (28.7% vs 8.8%) (P=0.011). The survival rate of patients in repair group was much higher than that of replacement group at 3 months, 1, 3, 5 years post-operation. However, the differences were not statistically significant (P=0.231, 0.089, 0.133, 0.078).
Conclusion: For moderate-to-severe tricuspid regurgitation leading to right heart failure, the early efficacy of tricuspid valve plasty is much better than that of tricuspid valve replacement. The mid-term recurrence rate after tricuspid valve repair is higher than that of replacement.