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%), lonescu‐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). The incidence of valve‐related events for bioprostheses implanted in the tricuspid position was: paravalvular leak (0%), thrombosis (1%), and endocarditis (2%). Seventeen patients (12.7%) had structural failure of a bioprosthesis in the tricuspid position, with 15 having a reoperation performed at a mean of 74 months post repair. Fourteen of the patients undergoing reoperation required tricuspid valve re‐replacement, and one a tricuspid valve thrombectomy. Actuarial freedom from tricuspid valve re‐replacement was 70% at 10 years. Different bioprosthesis type was the sole incremental risk factor for the requirement for late tricuspid valve re‐replacement (p = 0.0001). We conclude that bioprostheses in the tricuspid position are at relatively low risk of valve‐related events. However, there is an important hazard for decreased overall survival in these patients. Risk factors for premature