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Tricuspid valve prosthetic replacement. Early and late results with the Starr-Edwards prosthesis
Insights
This study reviewed 154 patients undergoing tricuspid valve replacement with Starr-Edwards ball valves. While early mortality was 28%, long-term survival and functional improvement were significant for survivors of combined valve replacements.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Tricuspid valve replacement using ball prostheses has been performed since the 1960s.
- Outcomes data for isolated and combined tricuspid valve replacement are essential for evaluating new prostheses.
Purpose of the Study:
- To review the Mayo Clinic's experience with Starr-Edwards ball-valve replacement of the tricuspid valve.
- To establish a benchmark for comparison with newer tricuspid valve prostheses.
Main Methods:
- Retrospective review of 154 patients undergoing tricuspid valve replacement between 1960 and 1971.
- Analysis of early mortality, long-term survival, and functional status post-surgery.
Main Results:
- Overall early mortality was 28%. Isolated tricuspid replacement had twice the early mortality of combined procedures.
- Among survivors, 70% (tricuspid/mitral) and 56% (triple valve) were alive at 3 years.
- Long-term functional improvement was high (94% and 93% respectively) among survivors.
Conclusions:
- Tricuspid valve replacement with Starr-Edwards ball valves demonstrated acceptable long-term outcomes, particularly in combined procedures.
- Preoperative New York Heart Association (N.Y.H.A.) Class IV and functional tricuspid insufficiency were associated with higher early mortality.
- This historical data provides a crucial standard for evaluating contemporary tricuspid valve prostheses.
Abstract:
The total experience (154 patients) with ball-valve (Starr-Edwards) replacement of the tricuspid valve, alone and in combination, through Dec. 31, 1971, at the Mayo Clinic is reviewed. The early mortality rate with isolated tricuspid replacement was twice that for tricuspid replacement combined with replacement of other valves. Among patients receiving three valves, those with "functional'' tricuspid insufficiency and those who were in New York Heart Association (N.Y.H.A.) Class IV preoperatively had a higher early mortality rate. The early mortality rate for the total group was 28%. Of those surviving tricuspid plus mitral valve replacement, 70% were alive at 3 years; at latest follow-up, 94% of those surviving were functionally improved. Of those surviving triple valve replacement, 56% were alive at 3 years; at latest follow-up, 93% of those surviving were functionally improved. Previous cardiac surgery with residual tricuspid valve dysfunction and severe disability, as judged by N.Y.H.A. class, influenced the outcome adversely. The experience reported here provides a standard against which never prostheses can be compared.
