Related Experiment Video
Updated: Aug 7, 2025
Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
Published on: June 8, 2022
Early and long-term outcomes of bioprosthetic versus mechanical tricuspid valve replacement: A nationwide
Suk Ho Sohn1, Yoonjin Kang1, Ji Seong Kim1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Insights
Mechanical tricuspid valve replacement offers better long-term survival compared to bioprosthetic options, especially for patients aged 54-65. This finding is crucial for optimizing patient outcomes in tricuspid valve surgery.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Health Services Research
Background:
- Tricuspid valve replacement is performed using either bioprosthetic or mechanical valves.
- Choosing the optimal prosthesis type is critical for long-term patient outcomes.
Purpose of the Study:
- To compare the early and long-term clinical outcomes of bioprosthetic versus mechanical tricuspid valve replacement.
- To identify the optimal prosthesis type based on patient age and survival rates.
Main Methods:
- A nationwide retrospective study utilizing the National Health Insurance Service database.
- 1241 patients undergoing tricuspid valve replacement (2003-2018) were analyzed.
- Propensity score matching and subgroup analysis (ages 50-65) were performed.
Main Results:
- No significant differences in operative mortality or postoperative complications.
- Mechanical valves showed lower all-cause mortality (4.6 vs 7.8 per 100 patient-years).
- Bioprosthetic valves had higher reoperation rates, while mechanical valves had higher stroke incidence.
Conclusions:
- Mechanical tricuspid valve replacement is associated with superior long-term survival.
- Mechanical prostheses demonstrated significantly better survival in patients aged 54-65.
Objectives:
We compared early and long-term clinical outcomes of bioprosthetic versus mechanical tricuspid valve replacement in a nationwide study based on the database from the National Health Insurance Service.
Methods:
Of 1425 patients who underwent tricuspid valve replacement from 2003 to 2018, 1241 patients were enrolled after excluding retricuspid valve replacement, complex congenital heart disease, Ebstein anomaly, and age less than 18 years at operation. Bioprostheses (group B) and mechanical prostheses (group M) were used in 562 patients (45.3%) and 679 patients (54.7%), respectively. The median follow-up duration was 5.6 years. Propensity score matching was performed. Subgroup analysis was performed in patients aged 50 to 65 years.
Results:
There was no difference in operative mortality or postoperative complications between the groups. All-cause mortality was higher in group B (7.8 vs 4.6 per 100 patient-years, hazard ratio, 1.75, 95% confidence interval, 1.33-2.30, P < .001). The cumulative incidence of stroke was higher in group M (hazard ratio, 0.65, 95% confidence interval, 0.43-0.99, P = .043), whereas the cumulative incidence of reoperation was higher in group B (hazard ratio, 4.20, 95% confidence interval, 1.53-11.54, P = .005). In terms of the age-dependent hazard of all-cause mortality, group B demonstrated a higher hazard than group M below the age of 75 years, and it was statistically significant between 54 and 65 years of age. In the subgroup analysis, all-cause mortality was also higher in group B.
Conclusions:
Mechanical tricuspid valve replacement demonstrated higher long-term survival than bioprosthetic tricuspid valve replacement. In particular, mechanical tricuspid valve replacement showed significantly higher overall survival between 54 and 65 years of age.
