By Lexa W. Lee
NEW ORLEANS -- November 12, 2008 -- There are no significant differences in long-term survival rates between patients who undergo tricuspid valve replacement (TVR) with mechanical valves or with bioprosthetic valves and no difference in the rate of repeated TVR necessary for these valves.
Investigator Toshihiro Funatsu, MD, National Cardiovascular Center, Osaka, Japan, and colleagues conducted a study to evaluate the surgical results of TVR in adults, especially with regard to the type of prosthetic valve used and its subsequent effects on operative mortality and rate of repeat TVR.
Their results were presented on November 11 here at the American Heart Association (AHA) Scientific Sessions.
The researchers examined data from 157 procedures performed in adults between 1978 and 2005. The 62 men and 95 women were aged 54 years on average. The procedures included 128 initial replacements and 29 repeat TVRs. The prosthesis used was mechanical in 35 cases and biological in 122 cases.
Clinical indications for TVR were combined valvular disease in 75 cases, congenital anomaly in 39 (Ebstein's anomaly 14), prosthetic valve dysfunction in 24, infective endocarditis in 6, and isolated tricuspid lesion and others in 13.
Patients were followed postoperatively on average for 8.6 years. There were 22 in-hospital deaths (14%) and 36 deaths during follow-up.
Survival rates at 3, 5, and 10 years were 82%, 79%, and 67% for mechanical valves and 79%, 73%, and 65% for bioprosthetic valves, respectively (P = .854). Rates of freedom from repeat TVR were 88% at 5 years and 74% at 10 years for mechanical valves, and 97% and 86% for bioprosthetic valves, respectively (P = .263).
Male gender (P = .0125) and acquired valvular disease (P = .0069) were significant predictors of in-hospital mortality, and age at surgery was the only predictor of repeat TVR.
Use of mechanical or bioprosthetic valves in patients receiving TVRs resulted in similar long-term survival rates and freedom from repeat TVR, the researchers concluded.
The long-term results were satisfactory, even if in-hospital mortality following TVR was relatively high because of the severity and complexity of patient illness, the researchers noted.
[Presentation title: Long-Term Clinical Results of Tricuspid Valve Replacement. Presentation 4282]
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