How to deal with recipients of valves prone to structural failure in the 2000s: Padua experience with the TRI Technologies valve.
BACKGROUND
TRI Technologies (TT) valves evidenced a propensity to structural failure, consisting in fracture of the pivoting system, leading to leaflet escape. At our institution, between 2000 and 2002, 36 TT valves were implanted in 34 patients. Here we report the final results of the Tritech survey program.


METHODS
In February 2002, the first valve-related death occurred. After the event, patients were enrolled in the TT valve survey program and strictly followed up. The option of a reintervention was advised to each patient and weighed against the redo operative risk. The prophylactic TT valve replacement program took place in two time frames, dependent on each patient's personal choice: between September 2002 and October 2003 (first phase), and between September 2004 and October 2004 (second phase). Overall, 22 (10 women, 12 men) patients underwent reoperation. Mean time interval between TT valve implantation and replacement was 23 +/- 11 months. Patients' mean age was 59 +/- 11 years (median age, 64 years).


RESULTS
All recipients adhering to the program successfully underwent reoperation. Operative mortality was 0%.


CONCLUSIONS
We believe that the timing of the second surgery was fundamental for the favorable outcome of each patient and the absence of operative mortality. We are convinced that the tailored programming of the reintervention, together with the strong motivation of each patient, contributed in minimizing the risks related to surgery. The circumscribed cohort of patients involved was compatible with a tailored therapeutic plan. We strongly advise prophylactic reoperation of recipients of TT valves.
Gerosa
Gino
G
Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, Padua University Medical School, Padua, Italy. gino.gerosa@unipd.it
Carta
Riccardo
R
Montisci
Massimo
M
Leoni
Loira
L
Iliceto
Sabino
S
Rizzoli
Giulio
G
di Marco
Francesca
F
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D003625:Data Collection; D016757:Death, Sudden, Cardiac / Q000209:etiology; D020878:Device Removal; D018572:Disease-Free Survival; D004867:Equipment Design; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D015397:Program Evaluation; D011475:Prosthesis Failure; D012086:Reoperation; D012306:Risk; D016019:Survival Analysis; D013923:Thromboembolism / Q000453:epidemiology