Our Summary

This study looks at how the characteristics and outcomes of patients who underwent a specific type of heart surgery, called tricuspid valve replacement (TVR), have changed over the last 45 years. The tricuspid valve is one of the four valves in the heart, and sometimes it can stop working properly and needs to be replaced.

The researchers collected information from all TVR surgeries that took place at Erasmus MC hospital from November 1972 to November 2017. They used statistical methods to identify which factors were linked to an increased risk of dying within 30 days of the surgery and other potential risk factors that could affect the patients’ outcomes.

They found that 98 patients, mostly women, had undergone a total of 114 TVR surgeries. The average age of the patients was around 50 years old. The main reason for needing the surgery changed over time. Between 1972 and 1985, the most common reason was a functional issue with the valve, while between 2001 and 2017, the most common reason was a disease called carcinoid heart disease.

The good news is that the rate of patients dying shortly after the surgery (early mortality) decreased significantly over time, from 35% in 1972-1985 to just 6.7% in 2001-2017. The study also identified several factors that influenced the risk of dying later on, such as the patient’s general health status, their blood hemoglobin levels, whether they had swollen legs before the surgery, and their kidney function.

About 44% of patients were still alive 10 years after the surgery, and this rate didn’t change much over time. The rate of needing another surgery within 10 years was 14.1% for patients with biological valves and 4.9% for those with mechanical valves.

In conclusion, the study found that the reasons for needing TVR surgery and the outcomes for patients have changed considerably over the last 45 years.

FAQs

  1. What were the significant predictors of 30-day mortality after a tricuspid valve replacement (TVR)?
  2. How has the aetiology of patients with tricuspid valve dysfunction changed over time?
  3. What factors influenced late mortality rates in patients who underwent TVR?

Doctor’s Tip

A helpful tip a doctor might tell a patient about valve replacement is to follow a healthy lifestyle, including regular exercise and a balanced diet, to improve overall heart health and reduce the risk of complications post-surgery. It is also important to attend all follow-up appointments and adhere to any medication or rehabilitation programs prescribed by the healthcare team.

Suitable For

Patients who are typically recommended valve replacement include those with severe tricuspid valve dysfunction, such as functional regurgitation or carcinoid heart disease. These patients may present with symptoms such as New York Heart Association class, leg edema, low preoperative hemoglobin, high central venous pressure, and elevated creatinine and alkaline phosphatase levels. Patients who have not responded to conservative management or other interventions may also be candidates for valve replacement. Overall, patient characteristics and outcomes have evolved over time, with improvements in early mortality rates and changes in aetiology impacting the patient population undergoing TVR.

Timeline

  • Before valve replacement: Patients with tricuspid valve disease may experience symptoms such as shortness of breath, fatigue, swelling in the legs, and abdominal discomfort. They may undergo diagnostic tests such as echocardiograms and cardiac catheterizations to determine the severity of their condition. Patients may also be prescribed medications to manage their symptoms.

  • After valve replacement: Following surgery, patients will typically spend some time in the hospital for recovery. They will be closely monitored for any complications and will receive physical therapy to aid in their recovery. Patients will also be prescribed medications to prevent infection and manage pain. Over time, patients may experience improvements in their symptoms and quality of life. Long-term follow-up care will be necessary to monitor the function of the replaced valve and address any potential issues that may arise.

What to Ask Your Doctor

  1. What is the reason for recommending valve replacement in my case?
  2. What are the different types of valve replacement options available and which one would be most suitable for me?
  3. What are the potential risks and complications associated with valve replacement surgery?
  4. What is the expected outcome of the surgery in terms of improving my symptoms and quality of life?
  5. How long is the recovery period after valve replacement surgery and what limitations or restrictions will I have during this time?
  6. Will I need to take any specific medications or follow-up treatments after the surgery?
  7. What lifestyle changes, if any, will I need to make after valve replacement surgery?
  8. How often will I need to have follow-up appointments or tests to monitor the function of the replaced valve?
  9. What are the long-term expectations for the durability of the replaced valve?
  10. Are there any specific signs or symptoms I should watch out for that may indicate a problem with the replaced valve?

Reference

Authors: Veen KM, Quanjel TJM, Mokhles MM, Bogers AJJC, Takkenberg JJM. Journal: Interact Cardiovasc Thorac Surg. 2020 Jun 1;30(6):896-903. doi: 10.1093/icvts/ivaa033. PMID: 32221593