title: Long-term tricuspid valve prosthesis-related complications in patients with congenital heart disease.
abstract: OBJECTIVE
  In patients with acquired valvar disease, morbidity and mortality rates after tricuspid valve replacement (TVR) are high. However, in adult patients with congenital heart disease, though data concerning outcome after TVR are scarce, even poorer results are suggested in patients with Ebstein anomaly. To investigate the applicability of these results to a broader array of congenital heart disease patients, we report the long-term follow-up of prosthesis-related complications, including re-replacement of patients with a tricuspid valve prosthesis and congenital heart disease.
  
  
  METHODS
  From the Dutch Congenital Corvitia (CONCOR) registry, we identified 20 patients with a biological or mechanical tricuspid valve prosthesis implanted between 1977 and 2012 (total of 31 prostheses). We analysed the tricuspid valve-related complications and mortality.
  
  
  RESULTS
  Ten patients with a median age of 16.2 years at the time of surgery (interquartile range 13.2-28.2 years) received a bioprosthesis while 10 patients with a median age of 36.4 years (interquartile range 14.0-47.0) at the time of surgery received a mechanical prosthesis (P = 0.28). During a mean follow-up of 14 years, 50% needed a re-replacement because of valve-related complications (e.g. valve degeneration or valve thrombosis). The yearly percentage of patients with valve-related complications was 4.2% in patients with a bioprosthesis and 2.7% in those with a mechanical prosthesis. Within 20 years of implantation, the median duration of event-free survival was significantly shorter in 3 patients with a prosthesis-patient mismatch (PPM; 1.0 year; interquartile range 0.01-2.6), compared with 7 without mismatch (8.0 years; interquartile range 5.1-12.3; P = 0.02).
  
  
  CONCLUSIONS
  Compared with previous literature on acquired valvar disease, we found a higher incidence of valve-related complications in patients with congenital heart disease that was unrelated to prosthesis material. Our data suggest that PPM may have a negative effect on the event-free interval.
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.
authors.forename: Ymkje J
authors.initials: YJ
authors.lastname: van Slooten
authors.forename: Hendrik G
authors.initials: HG
authors.lastname: Freling
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.forename: Monique R M
authors.initials: MR
authors.lastname: Jongbloed
authors.forename: Tjark
authors.initials: T
authors.lastname: Ebels
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D055815:Young Adult
keywords: CHD; Congenital heart disease; Heart valve prosthesis; Outcomes; Tricuspid valve