Tricuspid valve replacement: results of an orphan procedure - which is the best prosthesis?

Replacement of the tricuspid valve is uncommon. Prostheses specifically designed for this position are not available. Bovine, porcine as well as mechanical valve prostheses are currently used, however, the most suitable prosthesis type has not been defined.

We retrospectively analyzed all consecutive patients who underwent tricuspid valve replacement (TVR) at the Medical University of Vienna from 1996 to 2014. Baseline patient characteristics, prosthesis type, and postoperative outcome data were collected.

A total of 58 patients underwent TVR. Forty-one patients (71%) received biological (18 bovine, 23 porcine), and 17 patients (29%) mechanical prostheses. One-year survival (70.2% vs. 76.5%, P=0.18), and freedom from reoperation at one year (86.3% vs. 94.1%, P=0.35) was not significantly different bioprostheses and mechanical valves. Freedom from reoperation rates for bovine versus porcine prostheses (one-year: 88.2% vs. 84.4%, P=0.145) were also not significantly different. However, three bovine prosthesis had to be reoperated due to high-grade central regurgitation without any signs of endocarditis or structural valve degeneration.

There is a lack of clinical trials on tricuspid valve replacement and no specific guidelines for the choice of prosthesis. In the current study we have not identified significant differences in mortality between mechanical and biological valves. However, bovine prostheses seem less suitable for the tricuspid position due to the high closing volume with consecutive severe postoperative regurgitation.