Bioprosthetic Tricuspid Valve Research Articles

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HomeCirculationVol. 113, No. 18Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published9 May 2006https://doi.org/10.1161/circ.113.18.2165Circulation. 2006;113:2165CHARACTERISTICS AND BASELINE CLINICAL PREDICTORS OF FUTURE FATAL VERSUS NONFATAL CORONARY HEART DISEASE EVENTS IN OLDER ADULTS: THE CARDIOVASCULAR HEALTH STUDY, by Pearte et al.The aging of the population has brought increased focus onto the high morbidity and mortality of coronary heart disease (CHD) in the elderly. Pearte and colleagues examined the predictors and the temporal trends in CHD mortality in community-dwelling elderly adults participating in the Cardiovascular Heath Study. They observed that traditional risk factors and indicators of subclinical disease assessed before CHD event predicted an increased risk of CHD fatality. For instance, antecedent heart failure regardless of left ventricular systolic function conferred a 3-fold increased risk of death. The authors noted that although case-fatality decreased slightly over time, CHD remains lethal for almost one third of elderly individuals suffering a CHD event. In the era of personalized medicine, the authors argue that further efforts should be directed toward identifying effective strategies to prevent poor outcomes in high-risk elderly patients with CHD events. See p 2177.ROLE OF DIURETICS IN THE PREVENTION OF HEART FAILURE: THE ANTIHYPERTENSIVE AND LIPID-LOWERING TREATMENT TO PREVENT HEART ATTACK TRIAL, by Davis et al.High blood pressure is a key risk factor for congestive heart failure (CHF). The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized controlled comparison of chlorthalidone, amlodipine, and lisinopril (representing diuretics, calcium channel blockers, and angiotensin-converting enzyme inhibitors) for prevention of cardiovascular disease events in hypertensive patients. In this issue of Circulation, Davis and colleagues report on the relative effects of these 3 antihypertensive agents on rates of hospitalized/fatal CHF in ALLHAT. The authors observed that comparative risks for CHF in the 3 arms varied over time. In the first year of the trial, patients in the amlodipine and lisinopril arms experienced a 2-fold greater risk of CHF compared to those in the chlorthalidone arm. Beyond the first year, CHF risks were comparable for the chlorthalidone and lisinopril arms, but higher in the amlodipine arm. These differences in CHF rates in the 3 treatment arms were not explained by prior medication use or by the blood pressure level at baseline or on follow-up. These observations suggest that diuretics may be superior to calcium channel blockers for the prevention of CHF in hypertensive patients. See p 2201.OUTCOME OF WATCHFUL WAITING IN ASYMPTOMATIC SEVERE MITRAL REGURGITATION, by Rosenhek et al.Timing of surgery in patients with mitral regurgitation remains a challenge. Several recent studies have recommended liberalization of indications, particularly when mitral valve repair is feasible. Current published guidelines recommend watchful waiting, but the safety of this approach has not been prospectively evaluated. In this week’s journal, Rosenhek et al describe 132 consecutive asymptomatic patients with severe mitral regurgitation followed up for an average of just over 5 years. Patients were followed up with careful serial clinical evaluation and echocardiograms and were referred for surgery when they met guideline-based criteria. Overall survival was not different from expected survival. During follow-up, 38 patients met the criteria for surgery. Postoperative outcome was good in terms of survival, symptoms, and postoperative left ventricular function. This important prospective study provides further support for current guidelines that recommend “watchful waiting” for asymptomatic patients with severe mitral regurgitation. In addition, the study emphasizes the importance of careful clinical and echocardiographic vigilance in this setting. See p 2238.Visit http://circ.ahajournals.org:Images in Cardiovascular MedicineCompression of the Pulmonary Vein After Right-Sided Pneumonectomy. See p e743.Balloon Valvuloplasty of a Stenosed Bioprosthetic Tricuspid Valve. See p e745.Percutaneous Closure of a Left Ventricular Free-Wall Rupture Site. See p e748. Download figureDownload PowerPointBook ReviewThe Adrenergic Receptors in the 21st Century. See p e750.CorrespondenceSee p e751. Previous Back to top Next FiguresReferencesRelatedDetails May 9, 2006Vol 113, Issue 18 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.113.18.2165 Originally publishedMay 9, 2006 PDF download Advertisement

Balloon Valvuloplasty of a Stenosed Bioprosthetic Tricuspid Valve

Percutaneous balloon valvuloplasty is rarely used in stenotic bioprosthetic valves, especially in the tricuspid position. A 72-year-old woman presented with right heart failure and was found to have a stenosed tricuspid bioprosthetic valve with thickened and fused cusps with an estimated valve area of 1 cm2 (Figure 1; Movie). She had undergone 2 previous open heart surgeries 19 and 20 years previously: first aortic valve replacement (Bjork-Shiley prosthesis, Shiley, Inc, …

Valve-on-valve technique for replacement of degenerated tricuspid bioprosthetic valve without explantation

A 73-year-old woman admitted to our hospital with shortness of breath and edema of the lower extremities was diagnosed with right ventricular failure stemming from tricuspid valve regurgitation. She had undergone mitral valve replacement (MVR) with a mechanical valve at the age of 51, and reoperative MVR with mechanical valve, tricuspid valve replacement (TVR) with bioprosthetic valve, and pacemaker implantation at the age of 63. Reoperative TVR was performed when the patient failed to respond to drug therapy. A beating heart cardiopulmonary bypass procedure was performed in which only the bioprosthetic valve leaflet was excised, and reoperative TVR was performed with a 27-mm OptiForm mechanical mitral valve (Sulzer Carbomedics Inc., Austin, TX, USA) by the valve-on-valve technique. The operative course was uneventful. The technique used here appears to be an effective approach to reoperative TVR, in this instance making it possible to avoid the risks associated with excision of the old prosthesis.

Late results of bioprosthetic tricuspid valve replacement in Ebstein’s anomaly

Background. Historically, porcine bioprosthetic valves have poor durability in pediatric patients; nearly half will require replacement within 5 years. However, our early experience with patients having Ebstein’s anomaly suggests that tricuspid bioprostheses in this anomaly might have better durability. Methods. One hundred fifty-eight patients who received a primary tricuspid bioprosthesis because of tricuspid valve anatomy unsuitable for repair between April 1972 and January 1997 were reviewed. Results were analyzed and Kaplan-Meier curves were constructed to estimate patient survival and probability of remaining free of reoperation. Results. Follow-up of 149 patients (94.3%) who survived 30 days ranged up to 17.8 years (mean, 4.5 years). Ten-year survival was 92.5% ± 2.5% (SE), 129 late survivors (92.1%) were in New York Heart Association class I or II, and 93.6% were free of anticoagulation. Freedom from bioprosthesis replacement was 97.5% ± 1.9% at 5 years and 80.6% ± 7.6% at 10 and 15 years. Conclusions. Bioprosthesis durability in the tricuspid position in patients with Ebstein’s anomaly compares very favorably with bioprosthesis durability in other cardiac valve positions, especially for pediatric patients, and also compares favorably with tricuspid bioprosthesis durability in patients with other diagnoses.

Double-balloon dilatation of a stenosed bioprosthetic tricuspid valve in repaired tetralogy of Fallot

to comply with a sudden increase in blood flow, and the noncompliant PLA prevented the fall of pressure to normal. The occurrence ofrestenosis remains a possibility. At the 3-month follow-up visit, however, our pat ient was symptom free and had no evidence of hemodynamic deterioration as evaluated by color Doppler echocardiography. Surgical correction ofcor t r i a t r i a tum can be done with low mortali ty rate and excellent late results. 5 However, we believe tha t balloon dilatation of membrane could be considered a reasonable al ternative to surgical t reatment , especially if performed by intervent ional cardiologists with reasonable experience in the t ransseptal technique.

Serial Doppler echocardiographic evaluation of bioprosthetic valves in the tricuspid position

Objectives. This study sought to evaluate bioprosthetic valve dysfunction in the tricuspid position by serial Doppler echocardiography.Background. Few reports on the long-term results of tricuspid valve replacement with bioprosthetic valves are evaluated by serial Doppler echocardiography.Methods. Between September 1979 and December 1993, 95 patients underwent tricuspid valve replacement with bioprosthetic valves at our facility. Sixty patients who underwent serial Doppler echocardiographic examination at intervals of at least 2 years after operation were included in the final analysis. These patients were followed up from 1.5 to 13.0 years (mean 5.8 ± 2.5).Results. The actuarial rates of freedom from bioprosthetic valve stenosis and regurgitation at 10 years were 46% and 51%, respectively. The prevalence of bioprosthetic valve stenosis and regurgitation increased progressively in a linear manner beginning 1 or 2 years after tricuspid valve replacement. Right heart failure developed during follow-up in 20 of the 25 patients with bioprosthetic valve dysfunction.Conclusions. The long-term durability of bioprosthetic valves in the tricuspid position was substantially lower in our study than that reported in previous studies. Tricuspid bioprosthetic valve dysfunction increased progressively in a linear manner beginning 1 to 2 years after tricuspid valve replacement.

Percutaneous valvuloplasty to relieve stenosis of a bioprosthetic tricuspid valve in a patient with bacterial endocarditis

Percutaneous valvuloplasty to relieve stenosis of a bioprosthetic tricuspid valve in a patient with bacterial endocarditis

Early and Late Phase Events Following Bioprosthetic Tricuspid Valve Replacement

From 1961 through 1987, 9,247 patients underwent an intracardiac repair for valvular heart disease. Five hundred thirty patients had a procedure that included a tricuspid valve operation (6%), with tricuspid valve replacement performed in 175 patients (2%), of whom 154 had a bioprosthetic valve implanted (1.7%). These 154 patients with a bioprosthetic valve in the tricuspid position are the subject of this review. There were 27 males and 127 females. Ages ranged from 10 to 75 years. There was tricuspid valve insufficiency in 139 patients (90%), and stenosis plus insufficiency in 15 (10%). Carpentier-Edwards prostheses were implanted in 83 (54%), Ionescu-Shiley in 55 (35%), Hancock in 12 (8%), and Mitroflow in 4 (3%). Concomitant procedures were performed in 146 patients (95%). At least one previous operation had been performed in 86 patients (56%). Preoperatively, 139 patients were in functional Class III or IV (90%). Hospital death occurred in 20 patients (13%). Logistic regression analysis revealed that incremental risk factors for hospital death included increasing peripheral edema preoperatively (p = 0.04), and use of a Hancock prosthesis in the tricuspid position (p = 0.03). All 134 hospital survivors were followed at a mean of 66.01 months, range 1 to 162 months. There were 70 late deaths (52%). Log-rank test indicated that incremental risk factors for late death were: longer cross-clamp time at repair (p = 0.0007); higher pulmonary artery systolic pressure preoperatively (p = 0.01); earlier date of surgery (p = 0.03); and larger tricuspid prosthesis size (p = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)

Bioprosthetic tricuspid valve stenosis associated with extensive plaque deposition in carcinoid heart disease

Fig. 1. Case No. 2. Drawing of abdominal aorta in the 7%year-old woman who died from accidental head trauma. A, Anterior view showing the large aortic false channel and its relation to the major aortic branches. The aortic dissection, which never ruptured, was never diagnosed during life. B, At necropsy the abdominal aorta was opened longitudinally, permitting view of the entrance and exit tears, and the large thrombus-filled false channel.

Long-term results of Ionescu-Shiley valve in the tricuspid position

A retrospective analysis of the long-term results of using the Ionescu-Shiley pericardial bioprosthesis in the tricuspid position was carried out on 73 patients (8 men, 65 women). Of these procedures, ten were tricuspid valve replacement alone and the remainder were in combination with other valve procedures. The mean follow-up was 9.6 years (range, 4 to 18 years). The mean age of the patients was 53 years (range, 27 to 78 years). Seventy-one of the patients suffered tricuspid valve dysfunction from rheumatic heart disease. There were 13 postoperative deaths (within 30 days), giving a mortality rate of 17.8%. The actuarial survival at 10 years was 71% ± 4.2%. Of the survivors, 49 (79.6%) were in functional class I or II. Primary tissue valve failure in the tricuspid position occurred in 1 patient 12 years after implantation and required reoperation. In another patient bioprosthetic tricuspid valve endocarditis developed. There was no incidence of thromboembolic complications. We conclude that the lonescu-Shiley pericardial bioprosthesis was a satisfactory prosthesis in the tricuspid position in patients with acquired valvar dysfunction.

Balloon valvuloplasty for fungal endocarditis induced stenosis of a bioprosthetic tricuspid valve

Palliative treatment was provided without complications by double balloon valvuloplasty of a stenotic porcine tricuspid valve in a patient with fungal endocarditis. With two 15 mm diameter valvulotomy balloons the peak tricuspid gradient decreased from 21 to 7 mm Hg and valve area increased from 0.3 to 1.2 cm2. After the procedure the patient clinically improved; however, valve replacement was not performed as planned because the patient developed an intracranial hemorrhage. She subsequently died of complications of fungemia. The present report demonstrates the possible use of valvuloplasty as a palliative procedure in selected patients with valvular stenosis involved with endocarditis.

Endocardial Pacing Through a Prosthetic Tricuspid Valve

We describe a patient in whom permanent endocardial pacing was accomplished by passage of the electrode through a porcine bioprosthetic tricuspid valve, thereby obviating the need for a second thoracotomy. After 8 years of follow-up, the patient continues to do well with satisfactory pacing and bioprosthetic valve function at the first change of pulse generator.

Doppler and echocardiographic features of normal and dysfunctioning bioprosthetic valves

Echocardiographic and Doppler studies were performed on 183 clinically normal and 58 severely dysfunctioning bioprosthetic mitral, aortic and tricuspid valves. The valve dysfunction resulted from spontaneous cusp degeneration in 49 instances and from paravalvular regurgitation in 9. The pulsed Doppler study demonstrated regurgitant flow in 36 (92%) of 39 regurgitant valves and 8 (90%) of 9 paravalvular regurgitant valves. Diagnostic echocardiographic features were present in only 51 and 10% of the patients, respectively. Although the Doppler regurgitant jet was peripheral in seven of the nine patients with paravalvular regurgitation, it was not possible to differentiate these patients from those who had valve degeneration and cusp tear at the periphery of the valve ring. Eight patients presented with a musical holosystolic murmur of mitral insufficiency. In all eight there was a characteristic honking intonation on the audio signal and a striated shuddering appearance on the video Doppler signal. Ten stenotic mitral bioprosthetic valves (less than or equal to 1.1 cm2 valve orifice) were identified by Doppler study. Diagnostic echocardiographic features were present in only two of these patients. The Doppler-derived valve orifice dimension correlated well (r = 0.83) with cardiac catheterization values. Fourteen asymptomatic or minimally symptomatic patients had echocardiographically thickened mitral cusps (greater than or equal to 3 mm). These patients had a significantly (p less than 0.0001) smaller valve area as compared with normal control valves, and during 4 to 24 months of follow-up, five of these patients developed severe valve regurgitation or stenosis. Doppler ultrasound is more sensitive than echocardiography in diagnosing bioprosthetic valve stenosis and regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Balloon percutaneous valvuloplasty for stenotic bioprosthetic valves in the mitral position

Percutaneous balloon valvuloplasty is useful for treatment in some patients with valvular stenosis, including those with severe calcification of the valve. 1–4 One case of dilatation of a tricuspid bioprosthetic valve was reported, 4 but none at other positions has been reported. We report the performance and the angiohemodynamic effects of in vivo dilatation in 2 patients with stenotic bioprosthetic valves in the mitral position.

Tricuspid Stenosis in Prosthetic Valve Endocarditis: Diagnosis by Doppler Echocardiography

Valvular stenosis is an uncommon finding in bacterial endocarditis involving native cardiac valves. Prosthetic valve endocarditis, however, is more commonly associated with obstruction. Bioprosthetic cardiac valves may be particularly prone to this complication. A case of bioprosthetic tricuspid valve endocarditis with stenosis diagnosed by Doppler echocardiography and confirmed by operative findings is presented.

An eight-year experience with porcine bioprosthetic cardiac valves

A total of 589 porcine bioprostheses were implanted in 509 patients from January, 1976, through December, 1983. Of the valves implanted, 390 were Hancock and 199 were Carpentier-Edwards. A total of 1,633 patient-years was accrued, with a mean follow-up of 38 months per patient. Two hundred eight patients had aortic valve replacement, 209 had mitral valve replacement, and 79 had multiple valve replacements, of which 46 were aortic and mitral replacements. The mortality for isolated aortic valve replacement was 5.8%; for isolated mitral replacement, 8.6%, and for all patients, 10.9%. Late mortality was 3.9% per patient-year. The actuarial survival rate at 5 years was 79% for aortic, 68% for mitral, and 76% for aortic-mitral valve replacement. There were 12 thromboembolic events (0.73% per patient-year). Two episodes occurred in patients with an aortic bioprosthesis, nine in patients with a porcine mitral valve, and one in a patient with mitral and tricuspid bioprosthetic valves. The probability of remaining free of thromboembolism at 5 years was 99% for the group having aortic valve replacement, 93% for those having mitral replacement, and 100% for the group having aortic-mitral valve replacements. Thirteen episodes of endocarditis occurred (0.8% per patient-year). Seven of the 13 patients died as a direct result of endocarditis. The probability of remaining free of prosthetic endocarditis at 5 years was 97% for the aortic valve replacement group, 95% for the mitral group, and 97% for the aortic-mitral group. There were 20 instances of xenograft failure (1.2% per patient-year). The probability of remaining free of valve failure at 5 years was 96% for the aortic valve replacement group, 93% for the mitral group, and 93% for the aortic-mitral replacement group. Primary tissue failure of a prosthesis occurred in seven patients, all with Hancock valves (0.43% per patient-year). As yet there has been no primary tissue failure of the Carpentier-Edwards prosthesis. There also appears to be a lower incidence of thromboembolism (Edwards, 0.3% per patient-year; Hancock, 0.8% per patient-year) and endocarditis (Edwards, 0.6% per patient-year; Hancock, 1.0% per patient-year). The low incidence of complications with the porcine bioprosthetic valve, especially the Carpentier-Edwards, encourages us to recommend its continued use, especially in situations in which anticoagulation is contraindicated.

Influence of vegetation size on clinical outcome of right-sided infective endocarditis

Endocarditis involving right-sided valvular structures is largely a disease of intravenous drug abusers. The majority of these patients respond to antibiotic therapy with clearing of their bacteremia and preservation of their hemodynamic status. This study evaluated the prognostic value of echocardiographically determined vegetation size in 23 episodes of right-sided valvular endocarditis in 21 patients. Right-sided vegetations were visualized in 19 of 23 episodes (83 percent). Of these, a vegetation of 1.0 cm or greater was found in 11. No patient with an echocardiographically determined vegetation size of less than 1.0 cm required surgery, whereas four of 11 (36 percent) of those episodes in which the vegetation size was 1.0 cm or greater required surgery for persistent pyrexia (p <0.05). In all patients requiring surgery, a bioprosthetic tricuspid valve was placed at the time of initial surgery and in no patient did early reinfection occur. This study reconfirms the benign prognosis of right-sided valvular endocarditis. Further, although vegetations of less than 1.0 cm identify those patients who will respond to medical therapy, echocardiographically documented vegetations of 1.0 cm or greater are associated with a significantly lower response rate to appropriate medical therapy. The association of fever that persists for more than three weeks in the absence of another source of infection with an echocardiographically demonstrable right-sided vegetation of 1 cm or more identifies those patients who will require surgical intervention. Finally, tricuspid valve replacement can be performed at the time of initial surgery without undue concern for early reinfection or valve dysfunction.