Complications
Long-standing elevated right atrial pressure leads to atrial distension with reduced contractile reserve and atrial fibrillation. A small cohort study reported that 76% of patients who had previously undergone left-sided valve surgery were found to have preoperative fibrillation or flutter at admission for tricuspid valve surgery.[42]
Patients with chronic severe TR will often develop ascites from advanced liver disease, from chronic congestion or fibrosis (cardiac cirrhosis). A small cohort study reported that 30% of patients had ascites and 27% an elevated total bilirubin 2.0 mg/dL or greater prior to undergoing tricuspid valve surgery after left-sided valve surgery.[42]
Injury to the conduction tissue during tricuspid valve repair or replacement is uncommon. In a longitudinal study of 81 patients undergoing tricuspid valve replacement, 8.6% of patients required definitive pacemaker implantation following surgery.[43]
The right coronary artery can be injured during tricuspid valve repair or replacement. Suture placement can directly injure and kink the artery, both of which can result in arterial insufficiency and infarction.
Patients with mechanical valve replacement receive lifelong anticoagulation to reduce the risk of prosthetic valve thrombosis. The incidence depends on the type of prosthesis inserted, but is typically low. In one study of 265 patients over 10 years, the linearised rate of thrombosis was 0.8% per patient year for the St. Jude Medical valve.[44] Moreover, the mechanical thrombosis rate appears to be equivalent to the rate of bioprosthetic degeneration.[45]
Estimated at 1% per year.
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