The better substitute for tricuspid valve replacement in patients with severe isolated tricuspid regurgitation

Abstract

The better substitute for tricuspid valve replacement in patients with severe isolated tricuspid regurgitation Introduction Primary tricuspid valve regurgitation is rarely observed in adults and is known to result from congenital heart disease, rheumatic heart disease, myxomatous valve disease, infective endocarditis, carcinoid syndrome, and/or infiltrative valvulopathy (1). Tricuspid valve repair is the first option for patients with primary or secondary tricuspid regurgitation. However, valve replacement, instead of repair, may be better for those with severe structural valve dysfunction. In patients with isolated tricuspid valve regurgitation, tricuspid valve replacement (TVR) has been associated with a considerable reported risk of mortality and a high incidence of prosthesis-related complications, which could lead to a high number of reoperations (2). With regard to prosthesis, the choice between mechanical and bioprosthetic valves remains controversial. Furthermore, only a few studies have assessed the clinical outcomes of patients with primary tricuspid valve regurgitation after isolated TVR. The aim of the present study was to evaluate the long-term outcomes in patients undergoing first-time TVR with a mechanical or bioprosthetic valve for severe isolated tricuspid valve regurgitation. Methods Patients A total of 98 patients with primary tricuspid valve regurgitation underwent first-time TVR at the West China Hospital in China between January 2010 and March 2017. The prosthesis used was determined by the attending physician after considering age, symptoms, other comorbidities, and particularly the will of the patients. The present study was Objective: The ideal alternative for tricuspid valve replacement (TVR) in patients with severe isolated tricuspid regurgitation remains unclear. The aim of the present study was to retrospectively investigate the outcomes of using bioprosthetic and mechanical valves at the tricuspid position. Methods: A total of 98 consecutive patients without left-side cardiac disease or history of heart surgery who underwent first-time TVR between January 2010 and March 2017 at the West China Hospital, China were included in the study. Patient data, including all-cause death and need for tricuspid valve reoperation as the main end points, were retrospectively evaluated. Results: A total of 76 patients were enrolled into the study. The mean follow-up period was 43.3±21.9 (10-87) months. The mean age of the patients was 45.7±13.4 years. The study comprised 32.9% of male patients. During the follow-up period, 4, 3, 12, and 3 cases of death, reoperation, prosthesis dysfunctions, and prosthesis-related thrombosis were noted, respectively. Biological and mechanical valves were used in 56.6% and 43.4% of the patients, respectively. However, there was no significant difference between mechanical and biological valves with respect to echocardiographic date and survival, reoperation, prosthetic valve dysfunction, and thromboembolism rate. Conclusion: TVR is not a very high-risk procedure in pa...

Mechanical Tricuspid Valves Have Higher Rate of Reintervention: A Single Center Experience

“…Most of the published data found no difference in survival in patients who received mechanical versus bioprosthetic valves, 23) and few studies reported better survival in patients with mechanical 24 , 25) or tissue valves. 8) We did not report a significant difference in survival in patients with mechanical versus tissue valves.…”

“… 7) The reported mortality was as low as 3% in other reports. 8) The wide variability in mortality across the literature could be attributed to the different inclusion criteria and patients’ characteristics. In our study, we included all patients with isolated or combined TVR and those who had primary and reoperative surgery.…”

First case of tricuspid valve surgery in a neurofibromatosis type 1 patient

“…The latest studies published seem to agree that mid- and long-term follow-up of biological and mechanical prostheses do not differ in patients undergoing TVR. [ 13 14 ] This is confirmed by a large metanalysis that analyzed more than 2600 patients,[ 15 ] where was observed a higher risk of thrombosis in the case of mechanical TVR. This seems to endorse our philosophy of choosing a bioprosthetic valve in most of our TVR cases.…”

Tricuspid Valve Replacement: Mechanical or Biological Prostheses? A Systematic Review and Meta-Analysis

“…Based on our search terms and search strategies, the search results were shown in Figure 1 in line with the PRISMA flow chart. (Figure 1) A total of 13 studies [Songur 2014;Liang 2019;Wiedemann 2018;Redondo Palacios 2017;Hwang 2016;Mao 2016;Connolly 2015;Hwang 2014;Rodríguez-Capitán 2013;Cho 2013;Altaani 2013;Garatti 2012;Hwang 2012] with 1453 patients were analyzed, of which 793 patients received biological prostheses, while 660 patients received mechanical prostheses. Individual characteristics of the studies can be seen in Table 1.…”