title: Twenty-five year outcomes of tricuspid valve replacement comparing mechanical and biologic prostheses.
abstract: BACKGROUND
  Tricuspid valve replacement (TVR) has historically been associated with high mortality and morbidity, and current knowledge of long-term results of TVR is limited. This study reviewed our experience from a consecutive series at 2 institutions.
  
  
  METHODS
  Ninety patients (65 women [72%]; mean age, 53.8 ± 14.2 years; mean body surface area, 1.6 ± 0.2 m(2)) underwent TVR between January 1980 and December 2005. The etiology was secondary to left-heart valve disease in 56 patients (62%), degenerative disease in 16 (18%), Ebstein anomaly in 7 (8%), and endocarditis in 11 (12%). Seventy patients (78%) were in New York Heart Association class III or IV. Sixty patients (67%) underwent redo procedures. TVR was with a mechanical valve in 46 patients (51%) and a biologic prosthesis in 44 (49%).
  
  
  RESULTS
  The overall operative mortality was 17.7% (16 patients). During follow-up, 16 of the 74 survivors died. Kaplan-Meier survival at 5, 10, and 15 years was, respectively, 72%, 65%, and 63%. During follow-up, 16 patients (21.6%) underwent reoperation; among them, 8 with a mechanical valve underwent reoperation for tricuspid valve thrombosis and 6 with a biologic prosthesis for tricuspid valve deterioration. However, freedom from reoperation at 5 and 10 years was similar between mechanical (86% and 76%) and bioprostheses (97% and 83%). All 16 patients survived the reoperation.
  
  
  CONCLUSIONS
  The present experience suggests that the type of implanted prosthesis in the tricuspid position does not affect early and long-term outcomes or the reoperation rate. Timely referral before end-stage cardiac impairment develops could determine further outcomes improvement.
authors.affiliation: Department of Cardiovascular Disease E. Malan, Cardiac Surgery Unit, IRCCS Policlinico San Donato Hospital, Milan, Italy. agaratti@tiscali.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Garatti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Nano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.forename: Alberto
authors.initials: A
authors.lastname: Canziani
authors.forename: Tiziano
authors.initials: T
authors.lastname: Colombo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D055815:Young Adult