Long-term follow-up of patients with mechanical prosthetic valves in the tricuspid position

Abstract

It remains controversial whether biological or mechanical prostheses in the tricuspid position give better long-term results. The clinical advantage of mechanical prostheses is evaluated in this article. Our subjects were 25 consecutive patients who underwent tricuspid valve replacement (TVR) from January 1985. Five patients underwent TVR with mechanical prostheses (MP), and 20 patients had bioprostheses (BP). The mean age of the patients was 50.8 ± 15.9 years for those with MP and 50.2 ± 11.5 years old for those with BP. The preoperative New York Heart Association (NYHA) functional classification was 3.5 for those with MP and 3.1 for BP. The mean follow-up period was 5.05 ± 2.05 years for MP, ranging from 3 to 7 years, and 7.2 ± 5.6 years for BP, ranging from 1 to 12 years. No operative mortality occurred, but there was a single hospital death in a patient with BP due to sepsis after acute postoperative cholecystitis. One patient with BP suffered from neurological deficiencies. Long-term temporary cardiac pacing was required in one patient with MP and three with BP. A permanent cardiac pacemaker was implanted in one patient with BP. There was one late death in the MP group and three late deaths in the BP group. The actuarial survival rates at 5 and 7 years after surgery were 80% and 80%, respectively, for MP and 88% and 88% for BP. There was one embolic episode, a minor stroke, in the BP group. Four patients with BP had valvular dysfunction at 3, 8, 9, and 10 years after surgery, and two of these required re-TVR. Among BP patients, 93% were free from prostheses dysfunction at 5 years after surgery, and 78% were free from dysfunction after 10 years; all patients (100%) with MP were free from dysfunction at 7 years. This study suggests that TVR with MP shows no late complications and with careful anticoagulant therapy provides highly satisfactory follow-up results.