Redux cardiac surgery for tricuspid disease: A monocentric Tunisian cohort

Introduction Tricuspid disease is a major concern owing to its invaliding symptomatology and its impact on the right ventricular (RV) functions. The literature is suffering from a lack of studies making the therapeutic strategy a real challenge Objective To describe the clinical, echocardiographic and prognosis profile of patients undergoing a second cardiac surgery for a tricuspid disease and to deduce the main role of echocardiography in the surgical decision Method Retrospective study, from 2012 to 2019, including 10 patients with a history of isolated left valvular surgery underwent a redux cardiac surgery for a tricuspid disease. Results Most of patients were women (n = 9). The mean age of first intervention was 29 years old [10–48]. All these patients had a mitral and/or aortic valve replacement. None of our patients had significant tricuspid disease requiring surgical intervention with normal post operative echocardiography parameters. All of our patients were later hospitalized for a right cardiac decompensation. The mean period between the two surgeries was 21.5 years [7–36 years]. Echocardiography showed a tricuspid regurgitation (grade 4) in all our patients. The RV function was impaired in one patient, moderately lowed in 7 cases and preserved in only one case. Seven patients had a tricuspid plasty associated with a gesture on the pathology of the left heart and 3 patients had an isolated intervention on the tricuspid valve by a valve replacement by bioprosthesis. Only one patient died intraoperatively. Clinical and echocardiographic improvement was noted in all other patients during the follow-up. Conclusion Although tricuspid diseases are considered as the rarest valvular pathology, its involvement is a cornerstone for surgical decision. Thus, a regular echocardiographic monitoring of this valve remain mandatory to anticipate late damages and to restore as early as possible the therapeutic strategy which could be in some cases a real challenge.