Tricuspid regurgitation associated with mitral valve disease: repair and replacement.

Between January 1975 and June 1988, 156 patients with combined mitral and tricuspid valve disease underwent mitral and tricuspid valve repair or replacement. There were 127 (81%) patients with tricuspid valve repair and 29 (19%) patients with tricuspid valve replacement. Hospital mortality was 14% and was strongly influenced by preoperative pulmonary hypertension (systolic pressure greater than 65 mm Hg) and poor left ventricular function (ejection fraction less than 0.4). Five-year survival for the entire series was 57% +/- 5%; 12-year survival was 44% +/- 9%. Ejection fraction was the only age-adjusted risk factor for long-term survival. Of the patients who underwent tricuspid annuloplasty, 91% +/- 4% were free from reoperation after 10 years, indistinguishable from valve replacement (90% +/- 7%). Our tricuspid annuloplasty is simple and effective, and exhibits excellent long-term durability as well as immediate hemodynamic improvement.