Long-term clinical results of tricuspid valve replacement

Background. Tricuspid valve replacement (TVR) has been performed with mechanical or bioprosthetic valves. However, the relative advantages of the two types are incompletely known. Methods. Between 1978 and 2003, we performed 138 TVR (35 bioprosthetic, 103 mechanical) in 125 patients (50 men, 75 women), with a mean age of 43.7 +/- 16.6 years. The diseases that required TVR were rheumatic (94), prosthetic valve failure (14), congenital (14), infective endocarditis(5), isolated tricuspid regurgitation (4), and miscellaneous conditions (7). The operations included the following: isolated TVR (41), double valve replacement (58), and triple valve replacement (39). The follow-up rate was 98.3%, and cumulative follow-up was 828.5 patient-years. Results. There were 22 in-hospital deaths (17.6%) and 13 (10.4%) late deaths. Fourteen patients required additional operations. There were 33 postoperative valve-related events including 11 thromboembolisms and 3 bleeding episodes. Kaplan-Meier survival for the entire group at 15 years was 73.8 +/- 8.5% (bioprosthetic: 70.2 +/- 10.4%, mechanical: 66.0 +/- 19.4%). At 15 years, freedom from reoperation was 66.3 +/- 9.4% (bioprosthetic: 55.1 +/- 13.8%, mechanical: 86.0 +/- 6.2%) and freedom from valve-related events was 49.9 +/- 8.0%. The linearized incidence of valve thrombosis was 1.28%/ patient-year (bioprosthetic: 0, mechanical: 1.92), anticoagulation-related bleeding was 0.37%/patient-year (mechanical: 0.54), reoperation was 1.71%/patient-year (bioprosthetic: 2.68, mechanical: 1.25), and valve-related events were 4.33%/patient-year (bioprosthetic: 3.83, mechanical: 4.6). Conclusions. Both bioprosthetic and mechanical valves revealed similar long-term outcomes. However, findings suggest that greater care is needed to prevent valve thrombosis in mechanical valves in the early postoperative period, and there is a greater chance for reoperation in bioprosthetic valves.