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Ann Thorac Surg 2006;81:1317-1324
© 2006 The Society of Thoracic Surgeons
Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
Accepted for publication November 3, 2005.
* Address correspondence to Dr Chang, Division of Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, South Korea 120-752 (Email: bcchang{at}yumc.yonsei.ac.kr).
Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.
BACKGROUND: Tricuspid valve replacement (TVR) has been performed with mechanical or bioprosthetic valves. However, the relative advantages of the two types are incompletely known.
METHODS: Between 1978 and 2003, we performed 138 TVR (35 bioprosthetic, 103 mechanical) in 125 patients (50 men, 75 women), with a mean age of 43.7 ± 16.6 years. The diseases that required TVR were rheumatic (94), prosthetic valve failure (14), congenital (14), infective endocarditis(5), isolated tricuspid regurgitation (4), and miscellaneous conditions (7). The operations included the following: isolated TVR (41), double valve replacement (58), and triple valve replacement (39). The follow-up rate was 98.3%, and cumulative follow-up was 828.5 patient-years.
RESULTS: There were 22 in-hospital deaths (17.6%) and 13 (10.4%) late deaths. Fourteen patients required additional operations. There were 33 postoperative valve-related events including 11 thromboembolisms and 3 bleeding episodes. Kaplan-Meier survival for the entire group at 15 years was 73.8 ± 8.5% (bioprosthetic: 70.2 ± 10.4%, mechanical: 66.0 ± 19.4%). At 15 years, freedom from reoperation was 66.3 ± 9.4% (bioprosthetic: 55.1 ± 13.8%, mechanical: 86.0 ± 6.2%) and freedom from valve-related events was 49.9 ± 8.0%. The linearized incidence of valve thrombosis was 1.28%/patient-year (bioprosthetic: 0, mechanical: 1.92), anticoagulation-related bleeding was 0.37%/patient-year (mechanical: 0.54), reoperation was 1.71%/patient-year (bioprosthetic: 2.68, mechanical: 1.25), and valve-related events were 4.33%/patient-year (bioprosthetic: 3.83, mechanical: 4.6).
CONCLUSIONS: Both bioprosthetic and mechanical valves revealed similar long-term outcomes. However, findings suggest that greater care is needed to prevent valve thrombosis in mechanical valves in the early postoperative period, and there is a greater chance for reoperation in bioprosthetic valves.
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