Mechanical Tricuspid Valve Replacement Is Not Superior in Patients Younger Than 65 Years Who Need Long-Term Anticoagulation

Abstract

We evaluated long-term results of tricuspid valve replacement (TVR) with mechanical valves and bioprostheses in patients less than 65 years old who needed anticoagulation therapy irrespective of TVR. Among 156 patients who underwent TVR from January 1996 to April 2010, 119 patients younger than 65 years who needed anticoagulation therapy independent of the TVR were studied. Anticoagulation therapy was needed owing to left-sided mechanical valves (n = 11), atrial fibrillation (n = 13), or both (n = 95). Seventy patients underwent mechanical TVR, and 49 underwent bioprosthetic TVR. The follow-up duration was 68 ± 38 months. Propensity score-adjusted analyses were performed. Early postoperative outcomes were similar between groups, with an operative morality rate of 6.7% (8 of 119). Overall survival rates at 5 and 10 years were 86.4% and 80.3%, respectively. There were no differences in propensity score-adjusted overall survival rates between the two groups (p = 0.291). Freedom from the composite endpoint of thrombosis, embolism, and bleeding was lower in the mechanical TVR group than in the bioprosthetic TVR group (76.3% and 70.0% at 5 and 10 years, respectively, versus 97.6% and 97.6%, p = 0.020). Five- and 10-year valve-related event-free survivals were also lower in the mechanical TVR group than in the bioprosthetic TVR group, although not statistically significant (75.0% and 61.7% versus 89.2% and 80.3%, p = 0.129). Even in younger patients who need anticoagulation therapy irrespective of TVR, mechanical TVR is not superior because of increased occurrence of valve-related events, especially the composite of thrombosis, embolism, and bleeding.