Original article: cardiovascular
Tricuspid valve replacement: an analysis of 25 years of experience at a single center

https://doi.org/10.1016/S0003-4975(02)04162-0Get rights and content

Abstract

Background

Tricuspid valve replacement is seldom used in clinical practice, but the choice between mechanical and biologic prostheses remains controversial.

Methods

Between 1977 and 2002, 97 patients underwent tricuspid valve replacement and were followed at the Montreal Heart Institute Valve Clinic. Patients underwent replacement with bioprostheses (n = 82) and mechanical valves (n = 15).

Results

Patients with bioprosthetic tricuspid replacements averaged 53 ± 13 years of age compared with 48 ± 11 years in those with tricuspid mechanical valve replacements (p = 0.2). Isolated tricuspid valve replacement was performed in 11 patients (73%) in the mechanical valve group compared with 31 patients (38%. p = 0.01) in the bioprosthetic replacement group. In patients undergoing bioprosthetic tricuspid replacement, 51 (62%) underwent multiple associated valve replacements. The 5-year survival after tricuspid replacement averaged 60% ± 13% in the mechanical valve group and 56% ± 6% in the biologic replacement group (p = 0.8). The 5-year freedom rate from tricuspid valve reoperation averaged 91% ± 9% in patients with mechanical valves and 97% ± 3% in those with biologic valves (p = 0.2).

Conclusions

Patient survival after tricuspid valve replacement is suboptimal but related to the clinical condition at operation. The use of biologic prostheses for tricuspid valve replacement remains a good option in young patients because of limited life expectancy unrelated to the type of tricuspid prostheses at long-term follow-up.

Section snippets

Material and methods

Ninety-seven patients who underwent isolated, reoperative, or combined tricuspid valve replacement with an associated mitral or aortic replacement between 1977 and 2002 were reviewed. All patients were prospectively followed at the Montreal Heart Institute Valve Clinic with annual follow-up visits. The follow-up was complete in all except 3 patients (3%). The follow-up duration averaged 4 ± 5 years, ranging from 0 to 21 years. During the same period, 463 patients underwent a conservative

Characteristics of patients

Sixty-one women (74%) and 21 men (26%) with a mean age of 53 ± 13 years underwent tricuspid valve replacement with a bioprosthesis (group 1, n = 82), and 10 women (66%) and 5 men (33%) with a mean age of 48 ± 11 years underwent tricuspid valve replacement with a mechanical valve (group 2, n = 15). Congestive heart failure and prosthetic valve dysfunction were the two indications for operation in both groups (Table 1). Significant tricuspid regurgitation was the most common indication for

Comment

Tricuspid valve replacement remains the second and the last choice of treatment in patients with tricuspid regurgitation and in the rare occurrence of tricuspid stenosis in which repair is not feasible or has already failed. In the present study, most patients had previous left-sided valve replacements. Mechanical valves were most often used in patients undergoing isolated and reoperative tricuspid valve replacement as opposed to those undergoing combined tricuspid and left-sided valve

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    2022, Progress in Cardiovascular Diseases
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    It has been shown than porcine bioprostheses (such as the Hancock valve and the Carpentier-Edwards bioprostheses) in the TV position yield significantly better long-term results than those in the mitral position when the same bioprostheses were implanted in both mitral and TV positions in the same patient.15 Differences in pressure and velocity at the two valve locations with a lower pressure in the right side of the heart and a greater mechanical stress on the cusps at the mitral position are a more likely explanation for a longer durability of bioprosthetic valves and a lower rate of reoperation in the TV position.16 First studies published in the nineties reported a durability of bioprostheses in the TV position between 7 and 9 years, with a steeper increased rate of bioprosthetic valve degeneration after 7 years.17

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