Performance of Four Different Types of Mechanical and Two Bioprosthetic Valves in the Tricuspid Position
Experience with tricuspid valve replacement (TVR) was reviewed in 145 patients, operated on from June 1967 until December 1981 (28 single VR, 101 double VR, 21 triple VR). Eighty-five mechanical valves(15 KAY-SHILEY®, 23 BJÖRK-SHILEY®, 31 SMELOFF-CUTTER®, and 16 ST. JUDE MEDICAL®) and 65 bioprostheses (29 HANCOCK®, 36 CARPENTIER-EDWARDS® porcine) were implanted. Overall early mortality was 16.6% and late mortality 7.5% per patient-year. Minimum follow-up was 5.5 years; maximum 16 years. In the mechanical valve group, valve thrombosis occurred in 6 patients at 18-months postimplantation and was fatal in 5 cases. Late p annus formation occurred in 9 patients at 90-months postimplantation and was fatal in 5. Reoperation was performed in 7 patients receiving mechanical valves and was fatal in 2. The bioprosthesis group (implantation between 1975 and 1980) was free from thrombotic complications, except in 1 patient who had a reoperation for mitral valve replacement (MVR) and acute thrombosis of the tricuspid bioprosthesis, treated successfully by thrombectomy. Six other MVR/TVR patients needed MVR for primary valve dysfunction. One patient presented with tricuspid bioprosthetic valve degeneration with subsequent TVR. Following tricuspid valve replacement, actuarial survival is 60% at 9 years for bioprostheses and 75% at 6.5 years for ST. JUDE MEDICAL valves. Functional status is satisfactory. The actuarial probability of freedom of valve thrombosis is 96% for CARPENTIER-EDWARDS and 100% for HANCOCK at 8 and 9 years, respectively, and 92% for ST. JUDE MEDICAL valves at 6.5 years. We conclude that late survival is strongly influenced by the type of prosthesis used. The bioprosthesis performs best in the tricuspid position, and primary valve failure is of much lesser concern than in the mitral position. Of the mechanical substitutes used, only the ST. JUDE MEDICAL prosthesis has an adequate performance and a lower thrombosis occlusion rate at up to 6.5 years.
KeywordsMitral Valve Replacement Actuarial Survival Bioprosthetic Valve Heart Valve Replacement Mitral Position
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