title: Appraisal of Long-Term Outcomes of Tricuspid Valve Replacement in the Current Perspective.
abstract: BACKGROUND
  We address the differential long-term results of tricuspid valve replacement and late valve-related events among bioprostheses versus mechanical prostheses.
  
  
  METHODS
  In a single-institution investigation, we reviewed the patients' prospectively collected data and performed a clinical follow-up. Both the Kaplan-Meier (actuarial) and the competing risks (actual) methodologies were used.
  
  
  RESULTS
  Overall, 188 tricuspid valve replacements were performed during 1971 to 2012. In this complex population (reoperations, 48.1%; associated procedures in 71.3%), operative mortality was 27.6% (significantly declining in recent years). A bioprosthesis was used in 82.4%. Follow-up was 10.2 ± 9.1 years (as long as 37.3 years, or 1,270 patient-years; 91.2% complete). At 15 years, freedom from structural valve deterioration was 93.3% ± 6.4% (competing risks 94.7 ± 5.1%) in the mechanical group and 85.2% ± 5.4% (competing risks 92% ± 2.9%) in the bioprostheses group (p = 0.19). Freedom from any valve-related adverse events was lower among mechanical valves versus bioprostheses (although not statistically significant). Mechanical valves showed significantly lower freedom from thromboembolic events (actuarial 62.3% ± 14.3% versus 97.7% ± 1.6%; competing risks 74.1% ± 10% versus 98% ± 1.4%; p < 0.001) and earlier adverse events (4.9 ± 4.5 versus 11.1 ± 9.4 years) than bioprostheses. There were 11 reoperations for bioprosthetic structural valve deterioration (89.8% and 94.3% actuarial and actual freedom, respectively).
  
  
  CONCLUSIONS
  Bioprostheses for tricuspid valve replacement have a very good long-term durability. Mechanical valves display earlier and more severe morbidity at follow-up.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France. Electronic address: amedeo.anselmi@alice.it.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Anselmi
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Vito Giovanni
authors.initials: VG
authors.lastname: Ruggieri
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Majid
authors.initials: M
authors.lastname: Harmouche
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Flécher
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Corbineau
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Langanay
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Lelong
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
mesh_terms: D001705:Bioprosthesis; D005260:Female; D005544:Forecasting; D005602:France / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*