Ten Years' Experience of Surgical Management of Triple Valve Disease:Early and Late Results in Thirty-four Consecutive Cases

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Abstract
Ten years' surgical experience in 34 consecutive patients with triple valve disease is reviewed. All patients but two (94%) were in functional class III or IV (N.Y.H.A.) before surgery. Nineteen patients underwent triple valve replacement and 15 combined aortic and mitral valve replacement and tricuspid annuloplasty. The Björk–Shiley tilting disc valve prosthesis was employed for all valve replacements. The early mortality was 21% (4/19) for triple valve replacement and 20% (3/15) for combined aortic and mitral valve replacement and tricuspid annuloplasty. The risk factors which affected the operative mortality were functional class IV, age over 60 years, and radiological heart volume above 900 ml/m2 BSA. There were two late deaths, 45 and 48 months, respectively, after operation. One was caused by arrhythmia. The other was due to thrombotic encapsulation of the mitral valve prosthesis (0.8%/year). The overall 5-year survival rate, including early mortality, was 75% (15/20). Subjective improvement was noted in 92% and functional capacity (N.Y.H.A.) increased by at least one class in 84% of the long-term survivors. Twenty patients (10 in each group) were re-examined on average 2½ years after surgery. All the inserted prostheses exhibited a normal function. One patient had a slight residual tricuspid incompetence after annuloplasty, but it did not require reoperation. Two patients suffered non-fatal systemic embolization (1.6%/year) and one of them had residual symptoms. There were no episodes of thrombosis of the tricuspid valve prosthesis, pulmonary embolism or infective endocarditis during an average follow-up period of 4.4 years.