Can we repair The Organic Tricuspid Valve Lesions. Five Years Follow up and multi-centric Study.
Marwan H. Elkassas1, Hany Faisal1, Hasan Salah1, Osama A. Abbas2, Mohamed Hagag3.
1Suez Canal University, Cairo, Egypt, 2Ain Shams University, Cairo, Egypt, 3Menoufia, Menoufia, Egypt.
OBJECTIVE: Organic tricuspid valve often is rheumatic in its origin and found in association with other valve lesions, data on repair of organic tricuspid valve disease are not sufficient, controversy between repair and replacement still not well studied, and some said long results of such repair are not satisfactory. The aim was to evaluate the effectiveness of the repair in organic tricuspid lesions and its course over five years follows up
METHODS: From April 2008 to May 2012 we operated more than 650 valve replacement operations mostly in rheumatic patients in three different centers in our country, 83 patients underwent tricuspid repair on organic lesion, all were associated with others valve lesions. Surgical repair techniques included Commisurotomy, division of secondary chordae or even papillary muscle splitting, autologous pericardial patch augmentation of tricuspid valve leaflets, with ring or suture annuloplasty. Follow up was at least five years duration.
RESULTS: There were only two cases of mortality (2.4%). More than 93% of the patients had either no or only class one NYHA classification after the operation. More than (95%) of the patients had a very good and acceptable result over five years with either trivial or mild regurgitation or stenosis. Three cases (4.8%) had moderate to severe regurgitation/stenosis over time but only two (3.6%) needed reoperation after three and four years. One case had moderate regurgitation but continued on medical treatment with acceptable symptoms.
CONCLUSIONS: : Organic tricuspid valve lesions are repairable with acceptable early and mid-long term results. Tricuspid stenosis and mixed tricuspid valve lesions are challenging but still repairable
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