TRICUSPID-VALVE REPLACEMENT - PORCINE BIOPROSTHESES AND MECHANICAL PROSTHESES

The clinical performance of tricuspid valve replacement with bioprosth eses and mechanical prostheses was assessed in a series of 5,489 total valve replacement operations performed from 1975 to 1992. There were 97 (1.8%) tricuspid valve replacements in 94 patients (16 men, 78 wome n) with a mean age of 55.4 +/- 13.8 years. Bioprostheses (mean patient age, 55.9 +/- 14.1 years) were used in 83 operations and mechanical p rostheses (mean patient age, 52.1 +/- 11.9 years) were used in 14 oper ations. There were 30 isolated tricuspid valve replacements and 67 tri cuspid valve replacements incorporated in multiple valve replacements. The total cumulative follow-up was 360 patient-years (bioprostheses, 321 years; mechanical prostheses, 39 years) (96.8% complete). The mean follow-up was 3.7 years (bioprostheses, 3.9 years; mechanical prosthe ses, 2.8 years) (p = not significant). The early mortality was 14.4% ( bioprostheses, 14.5%; mechanical prostheses, 14.3%) (p = not significa nt) (isolated replacement, 13.3%; multiple replacement, 14.9%). The la te mortality was 9.2% per patient-year (isolated replacement, 12.2% pe r patient-year; multiple replacement, 7.9% per patient-year). The free dom from structural valve deterioration at 5 and 7 years was 100% for mechanical prostheses and 97.1% +/- 2.9% for bioprostheses (p = not si gnificant). For isolated tricuspid valve replacement, the freedom from structural valve deterioration for bioprostheses was 90.9% +/- 8.7% a t 5 years and at 7 years (p = not significant). For the mechanical pro stheses, the freedom was 100%. The freedom from valve-related reoperat ion for mechanical prostheses was 86.7% +/- 12.4% at 5 and 7 years; fo r bioprostheses, it was 97.1% +/- 2.9% at 5 years and 92.5% +/- 5.2% a t 7 years (p = not significant). There was one reoperation among the i solated replacements with bioprostheses (one of four), and freedom fro m reoperation for bioprostheses was 90.9% a 8.7% at 5 years and at 7 y ears (p = not significant). With multiple tricuspid valve replacement, the freedom from reoperation for mechanical prostheses was 84.6% +/- 14.2% at 5 and 7 years; for bioprostheses, it was 100% at 5 years and 93.8% +/- 6.1% at 7 years (p = not significant). Thrombosis was differ ent (p < 0.05): for overall tricuspid valve replacement, the freedom f rom thrombosis for mechanical prostheses was 90.9% +/- 8.7% at 5 and 7 years and for bioprostheses, it was 100%. In the tricuspid valve mult iple replacement group, the freedom from thrombosis for mechanical pro stheses was 88.9% +/- 10.5% at 5 and 7 years and for bioprostheses, it was 100% at both times (p = not significant). Tricuspid valve replace ment carries a high early and late mortality rate. Bioprostheses are r ecommended because of the low rate of structural valve deterioration a nd avoidance of thrombosis.