[Long-term results of tricuspid prostheses]

The results of a series of 38 patients with a tricuspid valve prostheses (:76% Starr-Edwards ball valves) associated with correction of one or two left heart valvular lesions are presented. 24 patients underwent clinical and haemodynamic assessment on average 4,2 years after surgery. The conclusions were that signs of systemic venous hypertension were mainly related to residual right ventricular failure despite normal valve function and secondarily to the poor hemodynamic profile of these prostheses and their paradoxical motion. Using these results: 18% early mortality; 24% late mortality; 24% late thrombosis amongst survivors and 52% residual right ventricular failure; and 47,5% of excellent results. The clinical and haemodynamic profiles of the patients were analysed to determine the surgical indications. Apart from the correction of associated left heart valve lesions, it seems that the prognosis in tricuspid valve repair depends on the duration of tricuspid regurgitation and the severity of right ventricular myocardial disease. In elderly patients with chronic tricuspid regurgitation and severe right ventricular failure, long-term analysis showed 87,5% poor results, whilst in younger patients with a shorter history of tricuspid regurgitation and less severe right ventricular failure, there was 77,7% excellent long-term results. Semi circular annuloplasty is widely indicated in mild or severe functional tricuspid regurgitation. Tricuspid valve replacement, a much more serious operation, remains essential in chronic organic lesions and in some cases of massive functional tricuspid regurgitation. A regards the choice of prosthesis, the authors suggest the Hancock bioprosthesis as a logical choice in cases of severe right ventricular failure as they are less prone to thrombosis than mechanical prostheses and have good haemodynamic profiles. The evolution of the right ventricular failure even after correction of tricuspid regurgitation underlines the importance of preventative therapy by early correction of left heart lesions.