The valve choice in tricuspid valve replacement: 25 years of experience

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Abstract
This study reviews 146 consecutive patients who underwent tricuspidvalve replacement (TVR) with 69 bioprostheses (porcine and bovinepericardial) and 77 mechanical ball, disc or bileaflet valves between 1967and 1987. The mean age was 51.4 +/- 12.1 years. Preoperatively, 97% were inNew York Heart Association (NYHA) functional class III or more and over 40%had undergone previous cardiac surgery. Hospital mortality was high(16.1%). Incremental risk factors for hospital death were preoperativeicterus (P < 0.01), hepatomegaly (P = 0.02), NYHA functional class IV (P= 0.02) and male sex (P = 0.04) (univariate analysis). Ninety-eight percentof the hospital survivors were followed up for a mean of 92 months.Cumulative follow-up added up to 955 patient-years. There were 70 latedeaths. The actuarial survival rate was 74% at 60 months and less than 25%at 14 years. Incremental risk factors for late death indicated byunivariate analysis were the type of tricuspid prosthesis (Smel-off-Cutterand Kay-Shiley prostheses) (P = 0.04), the type of operative myocardialprotection (normothermia and coronary perfusion) (P = 0.05) andpreoperative NYHA functional class IV (P = 0.05). We conclude that TVRcarries a high operative risk and poor long-term survival, both influencedby preoperative and perioperative variables. Bearing in mind the poorprognosis for TVR, we prefer a large-sized bioprosthesis, in view of itsinitial good durability and low risk of valve-related events. However, inpatients with good life expectancy, a bileaflet mechanical prosthesis maybe an acceptable alternative.

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