When should a mechanical tricuspid valve replacement be considered?

Sameh M. Said, Harold M. Burkhart, Hartzell V Schaff, Jonathan N. Johnson, Heidi M. Connolly, Joseph A. Dearani

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background Isolated mechanical tricuspid valve replacement (mTVR) is uncommon, early mortality is reported to be high, and little is known regarding the long-term outcome. We sought to evaluate the long-term outcome of mTVR. Methods From 1980 to 2007, isolated mTVR was performed in 64 patients (33 men) at our institution; the median age was 45.5 years (6-71 years). There were 2192 tricuspid valve (TV) repairs and 137 isolated bioprosthetic TV replacements during the same time interval. Valve dysfunction was caused by congenital TV abnormality in 45 patients (70%), carcinoid heart disease in 13 (20%), traumatic TV regurgitation in 3 (5%), and other reason in 3 (5%). Twenty-three patients (36%) had at least 1 previous cardiac procedure (TV repair in 8 and bioprosthetic TV replacement in 7). Results Mechanical prostheses used included Starr-Edwards (before 1993) in 36 patients (56%) and bileaflet prostheses in 28 (44%). Concomitant procedures included atrial septal defect closure in 28 (44%), arrhythmia surgery in 11 (17%), and pulmonary valvectomy for carcinoid disease in 10 patients (16%). Early mortality occurred in 5 patients (7.8%). Early morbidity included a permanent pacemaker in 9 (14%) and reexploration for bleeding in 2 patients (3%). Mean follow-up was 6 years (maximum 22.4 years). Five- and 10-year survival was 65% and 58%, respectively. There was no valve-related mortality. Late morbidity included valve thrombosis in 5 patients (8%); 3 were managed nonoperatively and 2 underwent TV rereplacement. Conclusions Isolated mTVR still leads to increased early mortality. A mechanical valve can be considered in select situations when anticoagulation is necessary and in the presence of good right ventricular function.

Original languageEnglish (US)
Pages (from-to)603-608
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number2
DOIs
StatePublished - 2014

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Tricuspid Valve
Mortality
Prostheses and Implants
Carcinoid Heart Disease
Morbidity
Right Ventricular Function
Tricuspid Valve Insufficiency
Atrial Heart Septal Defects
Carcinoid Tumor
Cardiac Arrhythmias
Thrombosis
Hemorrhage
Lung

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

When should a mechanical tricuspid valve replacement be considered? / Said, Sameh M.; Burkhart, Harold M.; Schaff, Hartzell V; Johnson, Jonathan N.; Connolly, Heidi M.; Dearani, Joseph A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 2, 2014, p. 603-608.

Research output: Contribution to journalArticle

Said, Sameh M. ; Burkhart, Harold M. ; Schaff, Hartzell V ; Johnson, Jonathan N. ; Connolly, Heidi M. ; Dearani, Joseph A. / When should a mechanical tricuspid valve replacement be considered?. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 148, No. 2. pp. 603-608.
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title = "When should a mechanical tricuspid valve replacement be considered?",
abstract = "Background Isolated mechanical tricuspid valve replacement (mTVR) is uncommon, early mortality is reported to be high, and little is known regarding the long-term outcome. We sought to evaluate the long-term outcome of mTVR. Methods From 1980 to 2007, isolated mTVR was performed in 64 patients (33 men) at our institution; the median age was 45.5 years (6-71 years). There were 2192 tricuspid valve (TV) repairs and 137 isolated bioprosthetic TV replacements during the same time interval. Valve dysfunction was caused by congenital TV abnormality in 45 patients (70{\%}), carcinoid heart disease in 13 (20{\%}), traumatic TV regurgitation in 3 (5{\%}), and other reason in 3 (5{\%}). Twenty-three patients (36{\%}) had at least 1 previous cardiac procedure (TV repair in 8 and bioprosthetic TV replacement in 7). Results Mechanical prostheses used included Starr-Edwards (before 1993) in 36 patients (56{\%}) and bileaflet prostheses in 28 (44{\%}). Concomitant procedures included atrial septal defect closure in 28 (44{\%}), arrhythmia surgery in 11 (17{\%}), and pulmonary valvectomy for carcinoid disease in 10 patients (16{\%}). Early mortality occurred in 5 patients (7.8{\%}). Early morbidity included a permanent pacemaker in 9 (14{\%}) and reexploration for bleeding in 2 patients (3{\%}). Mean follow-up was 6 years (maximum 22.4 years). Five- and 10-year survival was 65{\%} and 58{\%}, respectively. There was no valve-related mortality. Late morbidity included valve thrombosis in 5 patients (8{\%}); 3 were managed nonoperatively and 2 underwent TV rereplacement. Conclusions Isolated mTVR still leads to increased early mortality. A mechanical valve can be considered in select situations when anticoagulation is necessary and in the presence of good right ventricular function.",
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N2 - Background Isolated mechanical tricuspid valve replacement (mTVR) is uncommon, early mortality is reported to be high, and little is known regarding the long-term outcome. We sought to evaluate the long-term outcome of mTVR. Methods From 1980 to 2007, isolated mTVR was performed in 64 patients (33 men) at our institution; the median age was 45.5 years (6-71 years). There were 2192 tricuspid valve (TV) repairs and 137 isolated bioprosthetic TV replacements during the same time interval. Valve dysfunction was caused by congenital TV abnormality in 45 patients (70%), carcinoid heart disease in 13 (20%), traumatic TV regurgitation in 3 (5%), and other reason in 3 (5%). Twenty-three patients (36%) had at least 1 previous cardiac procedure (TV repair in 8 and bioprosthetic TV replacement in 7). Results Mechanical prostheses used included Starr-Edwards (before 1993) in 36 patients (56%) and bileaflet prostheses in 28 (44%). Concomitant procedures included atrial septal defect closure in 28 (44%), arrhythmia surgery in 11 (17%), and pulmonary valvectomy for carcinoid disease in 10 patients (16%). Early mortality occurred in 5 patients (7.8%). Early morbidity included a permanent pacemaker in 9 (14%) and reexploration for bleeding in 2 patients (3%). Mean follow-up was 6 years (maximum 22.4 years). Five- and 10-year survival was 65% and 58%, respectively. There was no valve-related mortality. Late morbidity included valve thrombosis in 5 patients (8%); 3 were managed nonoperatively and 2 underwent TV rereplacement. Conclusions Isolated mTVR still leads to increased early mortality. A mechanical valve can be considered in select situations when anticoagulation is necessary and in the presence of good right ventricular function.

AB - Background Isolated mechanical tricuspid valve replacement (mTVR) is uncommon, early mortality is reported to be high, and little is known regarding the long-term outcome. We sought to evaluate the long-term outcome of mTVR. Methods From 1980 to 2007, isolated mTVR was performed in 64 patients (33 men) at our institution; the median age was 45.5 years (6-71 years). There were 2192 tricuspid valve (TV) repairs and 137 isolated bioprosthetic TV replacements during the same time interval. Valve dysfunction was caused by congenital TV abnormality in 45 patients (70%), carcinoid heart disease in 13 (20%), traumatic TV regurgitation in 3 (5%), and other reason in 3 (5%). Twenty-three patients (36%) had at least 1 previous cardiac procedure (TV repair in 8 and bioprosthetic TV replacement in 7). Results Mechanical prostheses used included Starr-Edwards (before 1993) in 36 patients (56%) and bileaflet prostheses in 28 (44%). Concomitant procedures included atrial septal defect closure in 28 (44%), arrhythmia surgery in 11 (17%), and pulmonary valvectomy for carcinoid disease in 10 patients (16%). Early mortality occurred in 5 patients (7.8%). Early morbidity included a permanent pacemaker in 9 (14%) and reexploration for bleeding in 2 patients (3%). Mean follow-up was 6 years (maximum 22.4 years). Five- and 10-year survival was 65% and 58%, respectively. There was no valve-related mortality. Late morbidity included valve thrombosis in 5 patients (8%); 3 were managed nonoperatively and 2 underwent TV rereplacement. Conclusions Isolated mTVR still leads to increased early mortality. A mechanical valve can be considered in select situations when anticoagulation is necessary and in the presence of good right ventricular function.

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