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Late results of bioprosthetic tricuspid valve replacement in Ebstein's anomaly
H T Kiziltan1, D A Theodoro, C A Warnes
1Division of Thoracic and Cardiovascular Surgery, Section of Pediatric Cardiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Insights
Porcine tricuspid bioprosthetic valves show improved durability in patients with Ebstein's anomaly compared to other conditions. This finding offers better long-term outcomes for this specific patient group.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Biomaterials Science
Background:
- Porcine bioprosthetic valves historically demonstrate limited durability in pediatric patients, with high rates of reoperation within 5 years.
- Ebstein's anomaly presents unique challenges for tricuspid valve surgery, with prior assumptions of poor bioprosthetic valve durability.
Purpose of the Study:
- To evaluate the long-term durability and clinical outcomes of porcine bioprosthetic valves specifically in pediatric patients with Ebstein's anomaly.
- To compare the durability of tricuspid bioprostheses in Ebstein's anomaly patients against general pediatric populations and other cardiac valve positions.
Main Methods:
- Retrospective review of 158 patients who received a primary tricuspid bioprosthesis for Ebstein's anomaly between 1972 and 1997.
- Kaplan-Meier survival analysis was used to estimate patient survival and freedom from reoperation.
Main Results:
- Follow-up data from 149 patients (94.3%) revealed a 10-year survival rate of 92.5%.
- Freedom from bioprosthesis replacement was 97.5% at 5 years and 80.6% at 10 years.
- The majority of late survivors (92.1%) were in New York Heart Association class I or II, with 93.6% free from anticoagulation.
Conclusions:
- Tricuspid bioprosthetic valves in patients with Ebstein's anomaly exhibit favorable durability, outperforming those in other cardiac positions, particularly in pediatric cases.
- These findings suggest that porcine bioprostheses are a viable and durable option for tricuspid valve replacement in Ebstein's anomaly.
- The study supports improved long-term outcomes for pediatric patients with Ebstein's anomaly undergoing tricuspid bioprosthetic valve replacement.
Background:
Historically, porcine bioprosthetic valves have poor durability in pediatric patients; nearly half will require replacement within 5 years. However, our early experience with patients having Ebstein's anomaly suggests that tricuspid bioprostheses in this anomaly might have better durability.
Methods:
One hundred fifty-eight patients who received a primary tricuspid bioprosthesis because of tricuspid valve anatomy unsuitable for repair between April 1972 and January 1997 were reviewed. Results were analyzed and Kaplan-Meier curves were constructed to estimate patient survival and probability of remaining free of reoperation.
Results:
Follow-up of 149 patients (94.3%) who survived 30 days ranged up to 17.8 years (mean, 4.5 years). Ten-year survival was 92.5%+/-2.5% (SE), 129 late survivors (92.1%) were in New York Heart Association class I or II, and 93.6% were free of anticoagulation. Freedom from bioprosthesis replacement was 97.5%+/-1.9% at 5 years and 80.6%+/-7.6% at 10 and 15 years.
Conclusions:
Bioprosthesis durability in the tricuspid position in patients with Ebstein's anomaly compares very favorably with bioprosthesis durability in other cardiac valve positions, especially for pediatric patients, and also compares favorably with tricuspid bioprosthesis durability in patients with other diagnoses.