Tricuspid valve replacement with the St. Jude Medical valve: 19 years of experience

Objective: The choice of the valve substitute in the tricuspid position rem ains controversial. A St. Jude Medical valve is a choice of valve substitut e and its lower thrombogenicity and excellent hemodynamic performance have been reported even in the tricuspid position. However, little is known of t he long-term durability of the St. Jude Medical valve in the tricuspid posi tion. Our long-term experience of tricuspid valve replacement showed the hi gher thrombogenicity than we had expected, therefore, this study was done t o reconsider our strategy for valve choice. Methods. This study reviewed 23 patient who underwent 25 tricuspid valve replacements with the St. Jude Me dical valves from 1980 to 1997. The mean age was 40 years. Eleven patients (48%) were men. There were four in-hospital deaths (17%). The remaining 19 patients were all alive and followed from 2.2 to 19.0 years (mean 11.8 year s). Results: The overall survival, including hospital mortality, was 83%, 1 0 and 15 years after surgery. Valve thrombosis occurred in six patients. Fr eedom from valve thrombosis was 78 and 70%, 10 and 15 years after surgery, respectively. The linearized rate of the valve thrombosis was 2.9%/patient- years. Six patients required reoperation. The mean interval to reoperation was 9.5 years. Freedom from reoperation was 83% and 75%, 10 and 15 years af ter surgery, respectively. The linearized rate of the reoperation was 2.8%/ patient-years. No structural valve deterioration was found. Echocardiograph ic study showed that the function of the St. Jude Medical valve without val ve-related complications was well maintained. Conclusions: The higher throm bogenicity of the St. Jude Medical valve in the tricuspid position altered our choice of valve substitutes from the St. Jude Medical valve to a biopro sthesis which is lack of need for anticoagulant therapy except for juvenile patients who are able to maintain potent anticoagulant therapy. (C) 2000 E lsevier Science B.V. All rights reserved.