Long-term results of bioprosthetic tricuspid valve replacement: an analysis of 25 years of experience

Abstract

Current knowledge in long-term results of tricuspid valve replacement is limited. Present study reviews our experience from a consecutive series. We retrospectively studied the early and late results of 32 consecutive patients (7 male and 25 female; mean age 60.2±18.1years) undergoing bioprosthetic tricuspid valve replacement between 1985 and 2010. The etiology is rheumatic in 38%, congenital in 3%, endocarditis in 9%, and functional in 50%. Patients underwent isolated valve replacement. The remaining underwent combined aortic and tricuspid (n=5, 16%), mitral tricuspid (n=15, 47%), and aortic, mitral, and tricuspid (n=1, 3%) valve replacement. Preoperative liver dysfunction was evaluated using Model for End-stage Liver Disease (MELD) score. Mean follow-up was 5.6±6.8years (ranging from 0 to 25.0years). Hospital mortality was 19%. On univariate logistic regression analysis, NYHA class IV (p=0.039, odds ratio 11.3, 95% confidence interval 1.2-112.5), MELD score (>10) (p=0.011, odds ratio 21.0, 95% confidence interval 12.0-222.0) and congestive liver (p=0.05, odds ratio 9.4, 95% confidence interval 1.0-93.5) were incremental risk factors for hospital death. The 15- and 25-year actuarial survival were 56.5±10.3% and 45±13.0%, respectively. Multivariate analysis using Cox proportional hazard model showed MELD score (p=0.024, hazard ratio 7.0, 95% confidence interval 2.1-23.9) and postoperative pulmonary hypertension (p=0.012, hazard ratio 4.4, 95% confidence interval 1.4-14.1) were significantly associated with decreased survival. At 15years, freedom rates from tricuspid valve reoperation, anticoagulation-related bleeding, and valve related events were 85.7±13.2%,95.7±4.3% and 81.8±13.2%, respectively. The linearized incidence of structural valve deterioration was 0.50%/patient-year, anticoagulation-related bleeding was 0.94%/patient-year, and valve-related events were 1.52%/patient-year. Preoperative hepatic congestion and liver dysfunction which were indicated by the MELD score >10 were associated with poor outcome for patients undergoing tricuspid valve replacement. The MELD score is useful to predict the morality among these patients.