Tricuspid Valve Replacement: Bioprosthetic or Mechanical Valve?

Abstract

Significant morbidity and mortality is associated with tricuspid valve replacement, and controversy still exists as to the ideal prosthesis in this position. This study aimed to identify the risk factors for low cardiac output and mortality, and whether bioprosthetic or mechanical valves perform better in the tricuspid position. Results of 121 tricuspid valve replacements in 104 patients between January 1966 and December 2002 were reviewed. Most patients were in New York Heart Association functional class III or IV. Perioperative mortality was 19%. On multivariate analysis, age and preoperative jaundice were significant predictors of low cardiac output; age, jaundice, atrial fibrillation, and bypass time were significant predictors of mortality. Mechanical valves were significantly more prone to thromboembolism, whereas bioprostheses suffered structural valve deterioration. There were no significant differences in anticoagulation or bleeding episodes between the two groups, nor in valve-related events, deaths, and long term survival. There was no significant difference in performance so as to recommend one type over the other, but bioprosthetic valves may be more favorable as they fail predictably.

Should a Mechanical or Biological Prosthesis Be Used for a Tricuspid Valve Replacement? A Meta-Analysis

“…Based on our literature research strategy, 26 studies were identified, all of which were retrospective. Among these studies, the series of Rizzoli and colleagues, van Nooten and colleagues, Do and colleagues, and Hwang and colleagues were replicated in two different papers and the duplicated data were excluded to avoid estimation bias .…”

Utilization of the Edge‐to‐Edge Valve Plasty Technique to Correct Severe Tricuspid Regurgitation in Patients with Congenital Heart Disease

“…TVR is associated with high morbidity and mortality. The operative mortality for TVR was 14.3% to 24.5% 10‐13 . The late survival rate is also suboptimal with a 5‐year and 10‐year survival at 56% to 70% and 45% to 52%, respectively 10,14‐16 .…”

“…The operative mortality for TVR was 14.3% to 24.5%. [10][11][12][13] The late survival rate is also suboptimal with a 5-year and 10-year survival at 56% to 70% and 45% to 52%, respectively. 10,[14][15][16] TVP is superior to TVR with lower hospital mortality, fewer thromboembolic complications, and longer survival.…”

Anaesthesia for transvenous transcatheter tricuspid valve-in-valve implantation

“…9 Despite this controversy, the survival is probably similar for mechanical and bioprostheses. 8,10,11 Overall, the tricuspid valve is more prone to thrombosis and pannus formation, irrespective of whether a bioprosthesis or a mechanical valve is used. Pannus formation occurs mostly on the ventricular side and has a 35% incidence at five years' follow-up.…”