title: Tricuspid valve replacement: bioprosthetic or mechanical valve?
abstract: Significant morbidity and mortality is associated with tricuspid valve replacement, and controversy still exists as to the ideal prosthesis in this position. This study aimed to identify the risk factors for low cardiac output and mortality, and whether bioprosthetic or mechanical valves perform better in the tricuspid position. Results of 121 tricuspid valve replacements in 104 patients between January 1966 and December 2002 were reviewed. Most patients were in New York Heart Association functional class III or IV. Perioperative mortality was 19%. On multivariate analysis, age and preoperative jaundice were significant predictors of low cardiac output; age, jaundice, atrial fibrillation, and bypass time were significant predictors of mortality. Mechanical valves were significantly more prone to thromboembolism, whereas bioprostheses suffered structural valve deterioration. There were no significant differences in anticoagulation or bleeding episodes between the two groups, nor in valve-related events, deaths, and long term survival. There was no significant difference in performance so as to recommend one type over the other, but bioprosthetic valves may be more favorable as they fail predictably.
authors.affiliation: Department of Cardiothoracic Surgery, Green Lane Hospital, Auckland, New Zealand. nev_sheeba@yahoo.com
authors.forename: Neville A G
authors.initials: NA
authors.lastname: Solomon
authors.forename: Remy C H
authors.initials: RC
authors.lastname: Lim
authors.forename: Parma
authors.initials: P
authors.lastname: Nand
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality; D002315:Cardiopulmonary Bypass; D002648:Child; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011474:Prosthesis Design; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000473:pathology / Q000601:surgery*