TRICUSPID-VALVE REPLACEMENT - POSTOPERATIVE AND LONG-TERM RESULTS

A series of 146 consecutive patients who underwent tricuspid valve rep lacement at the University Brugmann Hospital between 1967 and 1987 was reviewed, Mean age at operation was 51.4 years (+/- 12.1 years). Diff erent types of prostheses were implanted including porcine and bovine pericardial bioprostheses and older and bileaflet mechanical valves. M ost patients were severely disabled by their cardiac disease before op eration, with 30.1% in New York Heart Association functional class III and 69.9% in class IV. Operative mortality and hospital mortality rat es (30 days) were high (16.4%). Incremental risk factors for hospital death included icterus (p < 0.005), preoperative hepatomegaly (p = 0.0 12), and New York Heart Association functional class IV (p = 0.013). M ultivariate analysis only selected preoperative icterus (p < 0.01) as being independently significantly related to hospital mortality. The h ospital survivors were followed up for a median of 94 months, A comple te follow-up was available for all patients except two for 30 months o r more. At 30 months the only two significant parameters were the type of myocardial protection (p 0.024) and the year of operation (before 1977 or after [precardioplegia era or after],p = 0.011), There were 70 late deaths during the entire follow-up period. The univariate (log-r ank statistics) incremental risk factor for late death was the type of tricuspid prosthesis (Smeloff-Cutter and Kay-Shiley versus St, Jude M edical versus bioprosthesis) (p = 0.04), A trend was observed for the type of operative myocardial protection (normothermia and coronary per fusion) (p 0.06) and preoperative New York Heart Association functiona l class IV (p = 0.055). Actuarial survival was 74% at 60 months and 23 .4% at 180 months. Cumulative follow-up added up to 1015 patient-years . In a more detailed analysis of the effect on survival of the type of tricuspid prosthesis, a significant difference was observed between t he bioprostheses and some older mechanical prostheses (Smeloff-Cutter and Kay-Shiley) (p = 0.04) but not between the bioprostheses and the b ileaflet valves (p = 0.15). When the follow-up period was stratified a ccording to less than 7 years and more than 7 years of follow-up, no d ifference was observed for the first period, but for the late follow-u p the new mechanical prostheses did better than the bioprostheses (p = 0.05), suggesting a degradation of the bioprostheses after 7 years an d favoring mechanical prostheses for those patients with a good long-t erm prognosis.