Long-term Outcomes of Mechanical Prosthetic versus Bioprosthetic Replacement in Tricuspid Position_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANGHuan-lei ¹ , XIEXu-jing ² , LUCong ¹ , XIAOXue-jun ¹ , WURuo-bin ¹ , LIUJing ¹ , CHENJi-mei ¹ ,  ZHUANGJian ¹

1. Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou 510100, P. R. China;
2. Department of Cardiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P. R. China;

Corresponding author：

ZHUANGJian, Email: zhuangjian5413@tom.com

Keywords：

Tricuspid valve replacement; Mechanical prosthetic valve; Biologic prosthetic valve

DOI：

10.7507/1007-4848.20150111

Video：

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Objective To compare the outcomes of mechanical prosthetic versus bioprosthetic replacement of tricuspid valve. Methods We retrospectively analyzed the clinical data of 344 patients underwent tricuspid valve replacement (TVR) in Guangdong General Hospital between January 2000 and December 2010. There were 227 female and 117 male patients with their age of 8-74 (42.0±13.3) years. We allocated the patients into two groups: 168 patients (48.8%) at age of 37.0±11.6 years underwent mechanical tricuspid valve replacement (the MTVR group) and 176 (51.2%) patients at age of 46.0±13.4 years underwent biological tricuspid valve replacement (the BTVR group). Follow-up data were obtained via patients' visiting the outpatient clinic, telephone or mail contacts. Results The mean follow-up time was 5.7 years (ranged from 2 months to 12.6 years). In the BTVR group, 149 patients survived to discharge from hospital, and 144 patients were followed-up successfully, giving a 96.6% follow-up rate. Early mortality (within 30 days post-operation) occurred in 29 patients (16.5%), and 14 patients (7.9%) died after 30 days post-operation. Eighteen bioprosthetic valve degeneration was found during follow-up, and infective endocarditis in 3 patients. In the MTVR group, 152 patients survived to discharge from hospital, 142 patients (93.4%) were followed-up. Early mortality in 13 patients (7.7%), and 14 patients (8.3%) died after 30 days post-operation. Nineteen patients suffered from mechanical prosthesis obstruction, no infective endocarditis patients was found in the MTVR group. There was no statistical difference between the BTVR group and the MTVR group in mortality rate (24.4% versus 16.1%, P=0.054) and in reoperation rate (4.2% versus 9.9%, P=0.051), respectively．There were statistical differences in long-term survival rates between the BTVR group and the MTVR group with 1 year survival rate(78% vs. 89%), 5 years survival rate(74% vs. 86%), and 10 years survival rate (66% versus 78%) with P value at 0.003. Conclusions This study suggests that the type of implanted prosthesis in tricuspid replacement does not affect long-term outcomes or the reoperation rate. The survival rate is higher in the MTVR group than that in the BTVR group, which may contribute to younger age in the MTVR group. There is a tendency in higher infective endocarditis incidence in the BTVR group than that in the MTVR group.

Citation： HUANGHuan-lei, XIEXu-jing, LUCong, XIAOXue-jun, WURuo-bin, LIUJing, CHENJi-mei, ZHUANGJian. Long-term Outcomes of Mechanical Prosthetic versus Bioprosthetic Replacement in Tricuspid Position. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 418-422. doi: 10.7507/1007-4848.20150111 Copy

1.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease:executive summary:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22):2438-2488.
2.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012):the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4):S1-S44.
3.	Ramakrishna H, Augoustides JGT, Gutsche JT, et al. Incidental tricuspid regurgitation in adult cardiac surgery:focus on current evidence and management options for the perioperative echocardiographer. J Cardiothorac Vasc Anesth, 2014, 28(5):1414-1420.
4.	Taylor JT, Chidsey G, DiSalvo TG, et al. Contemporary management of tricuspid regurgitation. An update clinical review. Cardiol Rev, 2013, 21(4):174-183.
5.	Chikwe J, Anyanwu AC. Surgical strategies for functional tricuspid regurgitation. Semin Torac Cardiovasc Surg, 2010, 22(1):90-96.
6.	Tapa R, Dawn B, Nath J. Tricuspid regurgitation:pathophysiology and management. Curr Cardiol Rep, 2012, 14(2):190-199.
7.	Izumi C, Miyake M, Takahashi S, et al. Progression of isolated tricuspid regurgitation late after left-sided valve surgery. Clinical features and mechanisms. Circ J, 2011, 75(12):2902-2907.
8.	Taramasso M, Vanermen H, Maisano F, et al. Te growing clinical importance of secondary tricuspid regurgitation. J Am Coll Cardiol, 2012, 59(8):703-710.
9.	Katsi V, Rafopoulos L, Aggeli C, et al. Tricuspid regurgitation afer successful mitral valve surgery. Interact Cardiovasc Thorac Surg, 2012, 15(1):102-108.
10.	Rizzoli G, Vendramin I, Nesseris G, et al. Biological or mechanical prostheses in tricuspid position? A meta-analysis of intrainstitutional results. Ann Torac Surg, 2004, 77(5):1607-1614.
11.	Hwang HY, Kim KH, Kim KB, et al. Mechanical tricuspid valve replacement is not superior in patients younger than 65 Years who need long-term anticoagulation. Ann Thorac Surg, 2012, 93(4):1154-1161.
12.	Nakano K, Eishi K, Kosakai Y, et al. Ten year experience with the Carpentier-Edwards pericardial xenograf in the tricuspid position. J Torac Cardiovasc Surg, 1996, 111(3):605-612.
13.	Guerra F, Bortolotti U, Thiene G, et al. Long-term performance of the Hancock porcine bioprosthesis in the tricuspid position. A review of forty-fve patients with fourteen-year follow-up. J Torac Cardiovasc Surg, 1990, 99(5):838-845.
14.	Carrier M, Hebert Y, Pellerin M, et al. Tricuspid valve replacement:an analysis of 25 years of experience at a single center. Ann Torac Surg, 2003, 75(1):47-50.
15.	Rizzoli G, De Perini L, Bottio T, et al. Prosthetic replacement of the tricuspid valve:biological or mechanical. Ann Torac Surg, 1998, 66(6):S62-S67.
16.	Garatti A, Nano G, Bruschi G, et al. Twenty-fve year outcomes of tricuspid valve replacement comparing mechanical and biologic prostheses. Ann Torac Surg, 2012, 93(4):1146-1153.
17.	Kaplan M, Kut MS, Demirtas MM, et al. Prosthetic replacement of tricuspid valve:bioprosthetic or mechanical. Ann Torac Surg, 2002, 73(2):467-473.
18.	Del Campo C, Sherman JR. Tricuspid valve replacement:results comparing mechanical and biological prostheses. Ann Torac Surg, 2000, 69(4):1295.
19.	Filsouf F, Anyanwu AC, Salzberg SP, et al. Long-term outcomes of tricuspid valve replacement in the current era. Ann Torac Surg, 2005, 80(3):845-850.
20.	Nakano K, Ishibashi-Ueda H, Kobayashi J, et al. Tricuspid valve replacement with bioprostheses:long-term results and causes of valve dysfunction. Ann Torac Surg, 2001, 71(1):105-109.

1. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease:executive summary:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22):2438-2488.
2. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012):the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4):S1-S44.
3. Ramakrishna H, Augoustides JGT, Gutsche JT, et al. Incidental tricuspid regurgitation in adult cardiac surgery:focus on current evidence and management options for the perioperative echocardiographer. J Cardiothorac Vasc Anesth, 2014, 28(5):1414-1420.
4. Taylor JT, Chidsey G, DiSalvo TG, et al. Contemporary management of tricuspid regurgitation. An update clinical review. Cardiol Rev, 2013, 21(4):174-183.
5. Chikwe J, Anyanwu AC. Surgical strategies for functional tricuspid regurgitation. Semin Torac Cardiovasc Surg, 2010, 22(1):90-96.
6. Tapa R, Dawn B, Nath J. Tricuspid regurgitation:pathophysiology and management. Curr Cardiol Rep, 2012, 14(2):190-199.
7. Izumi C, Miyake M, Takahashi S, et al. Progression of isolated tricuspid regurgitation late after left-sided valve surgery. Clinical features and mechanisms. Circ J, 2011, 75(12):2902-2907.
8. Taramasso M, Vanermen H, Maisano F, et al. Te growing clinical importance of secondary tricuspid regurgitation. J Am Coll Cardiol, 2012, 59(8):703-710.
9. Katsi V, Rafopoulos L, Aggeli C, et al. Tricuspid regurgitation afer successful mitral valve surgery. Interact Cardiovasc Thorac Surg, 2012, 15(1):102-108.
10. Rizzoli G, Vendramin I, Nesseris G, et al. Biological or mechanical prostheses in tricuspid position? A meta-analysis of intrainstitutional results. Ann Torac Surg, 2004, 77(5):1607-1614.
11. Hwang HY, Kim KH, Kim KB, et al. Mechanical tricuspid valve replacement is not superior in patients younger than 65 Years who need long-term anticoagulation. Ann Thorac Surg, 2012, 93(4):1154-1161.
12. Nakano K, Eishi K, Kosakai Y, et al. Ten year experience with the Carpentier-Edwards pericardial xenograf in the tricuspid position. J Torac Cardiovasc Surg, 1996, 111(3):605-612.
13. Guerra F, Bortolotti U, Thiene G, et al. Long-term performance of the Hancock porcine bioprosthesis in the tricuspid position. A review of forty-fve patients with fourteen-year follow-up. J Torac Cardiovasc Surg, 1990, 99(5):838-845.
14. Carrier M, Hebert Y, Pellerin M, et al. Tricuspid valve replacement:an analysis of 25 years of experience at a single center. Ann Torac Surg, 2003, 75(1):47-50.
15. Rizzoli G, De Perini L, Bottio T, et al. Prosthetic replacement of the tricuspid valve:biological or mechanical. Ann Torac Surg, 1998, 66(6):S62-S67.
16. Garatti A, Nano G, Bruschi G, et al. Twenty-fve year outcomes of tricuspid valve replacement comparing mechanical and biologic prostheses. Ann Torac Surg, 2012, 93(4):1146-1153.
17. Kaplan M, Kut MS, Demirtas MM, et al. Prosthetic replacement of tricuspid valve:bioprosthetic or mechanical. Ann Torac Surg, 2002, 73(2):467-473.
18. Del Campo C, Sherman JR. Tricuspid valve replacement:results comparing mechanical and biological prostheses. Ann Torac Surg, 2000, 69(4):1295.
19. Filsouf F, Anyanwu AC, Salzberg SP, et al. Long-term outcomes of tricuspid valve replacement in the current era. Ann Torac Surg, 2005, 80(3):845-850.
20. Nakano K, Ishibashi-Ueda H, Kobayashi J, et al. Tricuspid valve replacement with bioprostheses:long-term results and causes of valve dysfunction. Ann Torac Surg, 2001, 71(1):105-109.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Long-term Outcomes of Mechanical Prosthetic versus Bioprosthetic Replacement in Tricuspid Position

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