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Which is the best prosthesis in an isolated or combined tricuspid valve replacement?

Peng Liu1, Dong-Sheng Xia1, Wei-Hua Qiao2

  • 1Department of Cardiovascular Surgery, Fuwai Central China Cardiovascular Hospital, Henan Province People's Hospital, Henan Cardiovascular Hospital and Zhengzhou University, Zhengzhou, Henan, China.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|October 13, 2020
PubMed

Insights

For isolated tricuspid valve replacement, biological prostheses show better long-term outcomes than mechanical ones, particularly for patients without Ebstein's anomaly. This suggests individualized patient care for tricuspid valve prostheses.

Area of Science:

  • Cardiac Surgery
  • Cardiovascular Research
  • Prosthetic Valve Development

Background:

  • The optimal choice of tricuspid valve prostheses remains a subject of ongoing debate in cardiac surgery.
  • Comparing mechanical and biological prostheses is crucial for long-term patient management.

Purpose of the Study:

  • To compare the long-term results of mechanical versus biological prostheses in tricuspid valve replacement.
  • To evaluate outcomes in both isolated and combined tricuspid valve replacement surgeries.

Main Methods:

  • A retrospective study of 338 patients undergoing tricuspid valve replacement between 1999 and 2018.
  • Patients were categorized into isolated or combined surgery groups and received either mechanical or bioprosthetic valves.
  • Comparison of operative results, long-term survival, and tricuspid valve-related events.

Main Results:

  • Early mortality was higher in the combined group but similar between valve types. In isolated replacement, biological valves had a higher event-free rate (P=0.042), especially without Ebstein's anomaly (P=0.039).
  • No significant difference in event rates was found in the combined group (P=0.98).
  • Survival rates were comparable between mechanical and biological valves in both isolated (P=0.54) and combined (P=0.81) groups. Mechanical valves in isolated procedures showed higher risks of thrombosis and bleeding.

Conclusions:

  • Tricuspid valve prosthesis selection should be individualized.
  • Biological prostheses may be optimal for isolated tricuspid valve replacement, particularly in patients without Ebstein's anomaly.
  • Further research into patient-specific factors influencing prosthesis choice is warranted.
Abstract

Keywords:
Heart valve prosthesisMechanical or biological valveSurvival AnalysisTricuspid valve replacement

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