Heart, Lung and Circulation

Isolated Tricuspid Valve Surgery: The Auckland Experience 2011–2019

Published:October 25, 2021DOI:


      Isolated tricuspid valve surgery is an uncommon operation. Historical reports, including a previous review from our unit, demonstrated high morbidity and mortality associated with this operation. Many of these patients had severely impaired right ventricular function at the time of the surgery. Since our previous review, we have actively encouraged our local cardiologists to refer patients with severe isolated tricuspid disease for surgery before right ventricular remodelling occurs. This present study was performed to assess our current results.

      Material and Methods

      A prospectively-maintained hospital database was used to identify all adult non-congenital patients receiving standalone tricuspid valve repair or replacement at New Zealand’s largest cardiothoracic surgical unit from July 2011 to July 2019. Additional demographic and clinical data were collected by review of patient electronic records.


      During the 8-year study period, a total of 50 patients underwent isolated tricuspid valve surgery. Most patients were operated on for functional (40%) or rheumatic (30%) tricuspid disease. The majority of patients underwent surgery when the right ventricular function preoperatively was normal (30%) or mildly/moderately impaired (60%). Over half the patient sample (56%) underwent valve replacement. The 30-day mortality rate and stroke rate were 6% and 2% respectively. The medium-term survival was 80% at 4 years mean follow-up.


      Isolated tricuspid surgery is no longer a high mortality operation when it is performed on patients who have preserved right ventricular function.


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        • Fender E.A.
        • Zack C.J.
        • Nishimura R.A.
        Isolated tricuspid regurgitation: outcomes and therapeutic interventions.
        Heart. 2018; 104: 798-806
        • Adult Cardiac Surgery Database
        Executive Summary 10 Years (STS Period Ending 06/30/2017). Society of Thoracic Surgeons, United States of America.
        (Available at:)
        Date accessed: June 5, 2021
        • Raikhelkar J.
        • Lin H.M.
        • Neckman D.
        • Afonso A.
        • Scurlock C.
        Isolated tricuspid valve surgery: predictors of adverse outcome and survival.
        Heart Lung Circ. 2013; 22: 211-220
        • Mangoni A.A.
        • DiSalvo T.G.
        • Vlahakes G.J.
        • Polanczyk C.A.
        • Fifer M.A.
        Outcome following isolated tricuspid valve replacement.
        Eur J Cardiothorac Surg. 2001; 19: 68-73
        • Oh T.H.
        • Wang T.K.
        • Sidhu K.
        • Haydock D.A.
        Isolated tricuspid valve surgery at a single centre: the 47-year Auckland experience, 1965-2011.
        Interact Cardiovasc Thorac Surg. 2014; 18: 27-32
        • Hamandi M.
        • Smith R.L.
        • Ryan W.H.
        • Grayburn P.A.
        • Vasudevan A.
        • George T.J.
        • et al.
        Outcomes of isolated tricuspid valve surgery have improved in the modern era.
        Ann Thorac Surg. 2019; 108: 11-15
        • Wang T.K.M.
        • Griffin B.P.
        • Miyasaka R.
        • Xu B.
        • Popovic Z.B.
        • Pettersson G.B.
        • et al.
        Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients.
        Open Heart. 2020; 7: e001227
        • Baumgartner H.
        • Falk V.
        • Bax J.J.
        • De Bonis M.
        • Hamm C.
        • Holm P.J.
        • et al.
        • ESC Scientific Document Group
        2017 ESC/EACTS Guidelines for the management of valvular heart disease.
        Eur Heart J. 2017; 38: 2739-2791
        • Otto C.M.
        • Nishimura R.A.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin 3rd, J.P.
        • Gentile F.
        • et al.
        2020 ACC/AHA Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        Circulation. 2021; 143: e35-e71
        • Beckhoff F.
        • Alushi B.
        • Jung C.
        • Navarese E.
        • Franz M.
        • Kretzschmar D.
        • et al.
        Tricuspid regurgitation - medical management and evolving interventional concepts.
        Front Cardiovasc Med. 2018; 28: 49
      1. MedCalc Statistical Software version 19.2.6 (MedCalc Software bv, Ostend, Belgium.
        (Available at:)
        • Roudaut R.
        • Serri K.
        • Lafitte S.
        Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations.
        Heart. 2007; 93: 137-142
        • Staab M.E.
        • Nishimura R.A.
        • Dearani J.A.
        Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients.
        J Heart Valve Dis. 1999; 8: 567-574
        • Denault A.
        • Deschamps A.
        • Tardif J.C.
        • Lambert J.
        • Perrault L.
        Pulmonary hypertension in cardiac surgery.
        Curr Cardiol Rev. 2010; 6: 1-14
        • Wong W.K.
        • Chen S.W.
        • Chou A.H.
        • Lee H.A.
        • Cheng Y.T.
        • Tsai F.C.
        • et al.
        Late outcomes of valve repair versus replacement in isolated and concomitant tricuspid valve surgery: a nationwide cohort study.
        J Am Heart Assoc. 2020; 9: e015637
        • Bar N.
        • Schwartz L.A.
        • Biner S.
        • Aviram G.
        • Ingbir M.
        • Nachmany I.
        • et al.
        Clinical outcome of isolated tricuspid regurgitation in patients with preserved left ventricular ejection fraction and pulmonary hypertension.
        J Am Soc Echocardiogr. 2018; 31: 34-41
        • Giannini F.
        • Colombo A.
        Percutaneous treatment of tricuspid valve in refractory right heart failure.
        Eur Heart J Suppl. 2019; 21: B43-B47
        • Seo H.S.
        • Ha J.W.
        • Moon J.Y.
        • Choi E.Y.
        • Rim S.J.
        • Jang Y.
        • et al.
        Right ventricular remodeling and dysfunction with subsequent annular dilatation and tethering as a mechanism of isolated tricuspid regurgitation.
        Circ J. 2008; 72: 1645-1649
        • Saremi F.
        • Hassani C.
        • Millan-Nunez V.
        • Sánchez-Quintana D.
        Imaging evaluation of tricuspid valve: analysis of morphology and function with CT and MRI.
        AJR Am J Roentgenol. 2015; 204: W531-W542
        • Amsallem M.
        • Kuznetsova T.
        • Hanneman K.
        • Denault A.
        • Haddad F.
        Right heart imaging in patients with heart failure: a tale of two ventricles.
        Curr Opin Cardiol. 2016; 31: 469-482