Should the tricuspid valve be replaced with a mechanical or biological valve?

Kunadian, Babu; Vijayalakshmi, Kunadian; Balasubramanian, Sankar; Dunning, Joel

doi:10.1510/icvts.2007.159277

Cited by 39 publications

(26 citation statements)

References 12 publications

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“…Mechanical TVs carry the highest risk of thrombosis of any cardiac valve with an incidence of Յ3.3% of patient-years. 2 This was evident in our patient because thrombosis of the mechanical TV was not associated with a similar event on the mitral side. Although there are no published guidelines for the prevention of thrombosis in patients with mechanical TV, warfarin therapy aiming for a high therapeutic international normalized ratio value is often recommended with or without additional antiplatelet therapy.…”

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confidence: 51%

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Stuck Mechanical Tricuspid Valve Prosthesis

et al. 2012

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A 44-year-old woman underwent mitral valve and tricuspid valve (TV) replacement 6 years earlier using an ATS bileaflet tilting disc prostheses (ATS Medical Inc., Minneapolis, MN) for combined valvular stenosis and regurgitation because of rheumatic heart disease. On a routine clinic visit, the patient reported progressive fatigue and pedal edema over the previous few weeks. On physical examination, she was hemodynamically stable with evidence of elevated jugular venous pressure, hepatomegaly, and 3-mm pitting ankle and leg edema. Cardiac auscultation revealed closing and opening mechanical clicks; however, mitral and tricuspid clicks could not be distinguished. A grade 2/6 holodiastolic rumble and a grade 2/6 systolic murmur were audible at the left lower sternal border. An ECG showed atrial fibrillation with a ventricular rate at 75 beats per minute. Baseline laboratory investigations showed an international normalized ratio level of 1.8 with white cell count of 4960/mm 3 , erythrocyte sedimentation rate of 9 mm/h, and C-reactive protein level of 4 mg/L. Blood cultures were negative. A transthoracic echocardiogram showed both mechanical tricuspid discs stuck in a fully open position throughout the cardiac cycle ( Figure 1A and 1B and online-only Data Supplement Movies I and II). A mobile structure was intermittently noted in the medial inflow portion of the tricuspid prosthesis suggestive of either a thrombus or vegetation ( Figure 1C and online-only Data Supplement Movie III). Color Doppler showed diastolic turbulence across the TV with evidence of transvalvular tricuspid regurgitation ( Figure 1D and online-only Data Supplement Movie IV). On spectral Doppler, TV gradients were significantly elevated with absent valve clicks and prolonged pressure half-time (Figure 2). Findings of stuck TV discs were confirmed by fluoroscopy (Figure 3 and onlineonly Data Supplement Movie V) and transesophageal echocardiography (Figure 4 and online-only Data Supplement Movie VI). The latter also confirmed the presence of a small There is absence of opening and closing clicks of the tricuspid valve with markedly elevated gradients (peak/mean gradientsϭ26/16 mm Hg at heart rate of 72 beats per minute) and significant prolongation of the pressure halftime at 235 ms. Tricuspid regurgitation is also evident (arrow). From the King Faisal

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supporting

confidence: 51%

“…Mechanical valves carry a higher rate of thrombosis, whereas bioprosthetic valves have a higher rate of structural deterioration. 2 Reoperation and short-and long-term survival rates are similar among both valve types. 2 …”

mentioning

confidence: 88%

Stuck Mechanical Tricuspid Valve Prosthesis

et al. 2012

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“…43 Thrombosis with mechanical tricuspid valves is rare (Ͻ1% per year), and overall survival has been shown to be equivalent between bioprosthetic and mechanical valves in a recent large metaanalysis. 44 Thrombolysis is considered first-line therapy for tricuspid valve thrombosis, as opposed to left-sided valve thrombosis, for which the risks of systemic and cerebral embolism are increased. In patients undergoing sternotomy with underlying conduction disease, placement of an epicardial pacing electrode can avoid the subsequent need to pass a transvenous lead across the native valve.…”

Section: Current Practice Patterns and Guidelines For The Surgical Mamentioning

confidence: 99%

The Tricuspid Valve

2009

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Abstract-Cardiovascular specialists have entered an era of renewed interest and enthusiasm surrounding the diagnosis and treatment of valvular heart disease, driven in part by emerging percutaneous therapies for the treatment of aortic, pulmonic, and mitral valve disease. Despite this wave of investigation, little or no attention has been given to the treatment of tricuspid valve disease. Tricuspid regurgitation (TR) occurs mainly from tricuspid annular dilation, which can result from left-sided heart failure from myocardial or valvular causes, right ventricular volume and pressure overload, or dilation of cardiac chambers. If untreated at the time of surgical mitral valve repair, significant residual TR negatively impacts perioperative outcomes, functional class, and survival. TR does not reliably resolve after successful mitral valve surgery. If present at the time of mitral valve surgery, TR can usually be effectively addressed with ring annuloplasty. Because reoperations for recurrent TR carry high mortality rates, few patients are offered reoperation for redo tricuspid repair or replacement. As transcatheter therapies for mitral regurgitation arise, parallel percutaneous approaches for TR may be necessary. In this article, we review the anatomy, pathophysiology, and value of mechanical correction of TR, including potential transcatheter therapies for TR.

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“…For tricuspid valve replacement in the setting of traumatic TR most experts would prefer a bio prosthesis given the clinical condition, other associated injuries and anticoagulation issues 8 …”

Section: Discussionmentioning

confidence: 99%

Traumatic tricuspid valve regurgitation: A challenging case report

2020

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Traumatic tricuspid regurgitation (TR) is a rare cause of acute right ventricular dysfunction. The surgical technique could be complex and the reparative gesture has a lower success rate when compared with functional TR. We present the case of a 26‐year‐old male patient with traumatic TR who underwent tricuspid valve repair, with an initial satisfactory result. Later, the onset of acute severe residual TR was observed and the valve needed to be replaced. Surgery is the mainstay of treatment for traumatic TR, either in the form of repair or replacement. It requires an early diagnosis and concomitant treatment of injuries.

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Should the tricuspid valve be replaced with a mechanical or biological valve?

Cited by 39 publications

References 12 publications

Stuck Mechanical Tricuspid Valve Prosthesis

Stuck Mechanical Tricuspid Valve Prosthesis

The Tricuspid Valve

Traumatic tricuspid valve regurgitation: A challenging case report

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