title: Which type of valve should we use in tricuspid position? Long-term comparison between mechanical and biological valves.
abstract: BACKGROUND
  Nowadays, tricuspid valve replacement (TVR) is much less common than aortic or mitral valve replacement, since repair is almost always preferable. Prosthetic tricuspid valves are associated with high mortality and morbidity, mostly due to thrombotic or hemorrhagic events. Nevertheless, there is lack of evidence of which is the optimal type of valve (biological versus mechanical) in tricuspid position.
  
  
  METHODS
  We analyzed all the patients who underwent TVR in our Institution, from 2005 to 2015. Patient baseline characteristics were recorded (such as functional class, previous cardiac surgery, right ventricular dysfunction or pulmonary hypertension), and a clinical long-term follow-up was conducted. We compared the outcomes between mechanical and biological prostheses: in-hospital mortality, long-term mortality, need for reintervention and adverse events (such as stroke or valve thrombosis).
  
  
  RESULTS
  During the study period 120 tricuspid prosthetic valves were implanted in 111 patients. 81 of them (67.5%) were bioprostheses, and 39 (32.5%) mechanical valves. 73 patients (60.8%) had undergone a previous cardiac surgery (28.4% had previous tricuspid surgery). Most of the patients (87.1%) were in high functional class (grade III-IV of the NYHA classification), and 85% had moderate to severe pulmonary hypertension. Mean logistic EuroSCORE I was 14.80%. Only 37 cases were isolated TVR (30.6%), as most of the cases were TVR concomitant to mitral valve replacement. In-hospital mortality was 21.7%, and during the follow-up (mean follow-up of 7 years) reached 37.5%. Three mechanical tricuspid valves (7.7%) had to be replaced due to thrombosis, while 7 biological valves (8.6%) had to be replaced due to valve deterioration. The incidence of stroke was 7.5%.
  
  
  CONCLUSIONS
  Tricuspid valve replacement is an infrequent procedure with a high incidence of perioperative morbidity and mortality. Biological or mechanical valves have similar mortality, and a reasonably low incidence of need for reintervention due to thrombosis or valve deterioration.
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain - a.redondopalacios@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Redondo Palacios
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: López Menéndez
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Miguelena Hycka
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Miren
authors.initials: M
authors.lastname: Martín García
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Varela Barca
authors.affiliation: Department of Congenital Cardiac Surgery.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferreiro Marzal
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Muñoz Pérez
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Oliva de Anquín
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: García Andrade
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Tomasa
authors.initials: T
authors.lastname: Centella Hernández
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Celemín Canorea
authors.affiliation: Department of Adult Cardiovascular Surgery, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rodríguez-Roda Stuart
mesh_terms: D000368:Aged; D001705:Bioprosthesis; D016208:Databases, Factual; D020878:Device Removal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D013927:Thrombosis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*