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Sohn SH, Kang Y, Kim JS, Hwang HY, Kim KH, Choi JW. Early and long-term outcomes of bioprosthetic versus mechanical tricuspid valve replacement: A nationwide population-based study. J Thorac Cardiovasc Surg 2024; 167:2117-2128.e11. [PMID: 36894350 DOI: 10.1016/j.jtcvs.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We compared early and long-term clinical outcomes of bioprosthetic versus mechanical tricuspid valve replacement in a nationwide study based on the database from the National Health Insurance Service. METHODS Of 1425 patients who underwent tricuspid valve replacement from 2003 to 2018, 1241 patients were enrolled after excluding retricuspid valve replacement, complex congenital heart disease, Ebstein anomaly, and age less than 18 years at operation. Bioprostheses (group B) and mechanical prostheses (group M) were used in 562 patients (45.3%) and 679 patients (54.7%), respectively. The median follow-up duration was 5.6 years. Propensity score matching was performed. Subgroup analysis was performed in patients aged 50 to 65 years. RESULTS There was no difference in operative mortality or postoperative complications between the groups. All-cause mortality was higher in group B (7.8 vs 4.6 per 100 patient-years, hazard ratio, 1.75, 95% confidence interval, 1.33-2.30, P < .001). The cumulative incidence of stroke was higher in group M (hazard ratio, 0.65, 95% confidence interval, 0.43-0.99, P = .043), whereas the cumulative incidence of reoperation was higher in group B (hazard ratio, 4.20, 95% confidence interval, 1.53-11.54, P = .005). In terms of the age-dependent hazard of all-cause mortality, group B demonstrated a higher hazard than group M below the age of 75 years, and it was statistically significant between 54 and 65 years of age. In the subgroup analysis, all-cause mortality was also higher in group B. CONCLUSIONS Mechanical tricuspid valve replacement demonstrated higher long-term survival than bioprosthetic tricuspid valve replacement. In particular, mechanical tricuspid valve replacement showed significantly higher overall survival between 54 and 65 years of age.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Saad Shaukat MH, Stys J, Stys A, Stys T. Transcatheter tricuspid valve-in-valve implantation for very early bioprosthetic tricuspid stenosis secondary to pacemaker lead entrapment: a case report. Eur Heart J Case Rep 2022; 6:ytac251. [PMID: 35799681 PMCID: PMC9257794 DOI: 10.1093/ehjcr/ytac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/22/2022] [Accepted: 06/22/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Tricuspid stenosis (native and prosthetic) is rare. Redo-sternotomy for isolated tricuspid replacement is associated with a higher risk. The efficacy and durability of transcatheter valve implantation for severe tricuspid stenosis are unclear.
Case summary
Successful tricuspid valve-in-valve implantation (Edwards 26 mm Ultra) was performed to exteriorize a retained, unextractable pacemaker lead causing very early surgical bioprosthetic valve dysfunction in a 66-year-old Caucasian woman. The original indication for surgical replacement was pacemaker lead-related severe tricuspid regurgitation. History of CABG and subsequent surgical replacement rendered the risk of a third sternotomy and open-heart surgery prohibitive.
Conclusion
Successful reduction in the severity of bioprosthetic tricuspid stenosis and improvement of right heart failure with transcatheter valve-in-valve implantation was observed. Percutaneous tricuspid valve implantation could be considered an alternative to redo-sternotomy for severe bioprosthetic tricuspid stenosis.
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Affiliation(s)
- Muhammad Hamza Saad Shaukat
- Sanford Cardiovascular Institute, University of South Dakota , USDSOM, 1301 W 18th Street, Sioux Falls, SD 57105, Sioux Falls, SD , USA
| | - Julia Stys
- Sanford School of Medicine, University of South Dakota , Sioux Falls, SD , USA
| | - Adam Stys
- Sanford Cardiovascular Institute, University of South Dakota , USDSOM, 1301 W 18th Street, Sioux Falls, SD 57105, Sioux Falls, SD , USA
| | - Tomasz Stys
- Sanford Cardiovascular Institute, University of South Dakota , USDSOM, 1301 W 18th Street, Sioux Falls, SD 57105, Sioux Falls, SD , USA
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Dreyfus J, Dreyfus GD, Taramasso M. Tricuspid valve replacement: The old and the new. Prog Cardiovasc Dis 2022; 72:102-113. [PMID: 35738423 DOI: 10.1016/j.pcad.2022.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
Tricuspid regurgitation is a frequent and serious condition but tricuspid valve (TV) surgery, that may be a valve replacement when a repair is not feasible, is rarely performed. Recent development of transcatheter TV interventions offers new options for those high-surgical risk patients, especially TV replacement for patients who are not eligible for transcatheter TV repair. In this review, we describe indications and outcome after surgical TV replacement, and devices available or in development for transcatheter TV replacement.
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
| | - Gilles D Dreyfus
- Department of Cardiac Surgery, Montsouris Institute, Paris, France
| | - Maurizio Taramasso
- Cardiovascular Surgical Department, University Hospital of Zurich, Zurich, Switzerland
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Park B, Jeong DS, Kim WS, Sung K, Park PW. Reappraisal of mechanical tricuspid valve replacement in the current era: a single center retrospective study. J Thorac Dis 2021; 13:3359-3368. [PMID: 34277032 PMCID: PMC8264679 DOI: 10.21037/jtd-20-3027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022]
Abstract
Background This study aimed to investigate the early and late outcomes of mechanical tricuspid valve replacement (mTVR). Methods We evaluated 113 patients (82 women; median age, 53 years) who underwent mTVR between 1995 and 2017. Based on a history of cardiac surgery, patients were divided into primary (n=42) and reoperative mTVR (n=71) groups. The median follow-up duration was 12.7 years in primary and 9.3 years in reoperative mTVR, respectively (P=0.045). Results Patients in the reoperative group were older (54 vs. 46 years; P=0.007) and showed higher central venous pressure (16±6 vs. 13±6 mmHg; P=0.002) than the primary group. Early mortality occurred in 2 patients in the reoperative group (2 vs. 0; P=0.529). There was no significant difference in overall survival between the primary and reoperation groups (15-year survival rate: 86% vs. 78%; P=0.215). The independent risk factors of overall survival were age [P<0.001; hazard ratio (HR), 1.11; 95% confidential interval (CI), 1.05–1.18], left ventricular ejection fraction of less than 40% (P=0.001; HR, 5.1; 95% CI, 2.21–28.2), and central venous pressure over 20 mmHg (P=0.016; HR, 3.7; 95% CI, 1.28–10.7). Overall survival did not differ between the age groups (<60 vs. 60–70 years) in the reoperative group (P=0.772). Tricuspid valve thrombosis occurred in 8 patients (7 primary, 1 reoperative; P=0.004). Conclusions The incidence of tricuspid valve thrombosis was significantly higher in the primary mTVR group compared with the reoperative mTVR group. The patients who underwent mTVR at a relatively young age showed good early and late outcomes in both groups.
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Affiliation(s)
- Byungjoon Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Mediplex Sejong Hospital, Incheon, Korea
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5
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Mechanical Versus Bioprosthetic Valve Replacement in the Tricuspid Valve Position: A Systematic Review and Meta-Analysis. Heart Lung Circ 2021; 30:362-371. [DOI: 10.1016/j.hlc.2020.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 02/19/2020] [Accepted: 03/11/2020] [Indexed: 11/18/2022]
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6
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Cheng Y, Mo S, Wang K, Fan R, Liu Y, Li S, Zhang X, Yin S, Xu Y, Tang B, Wu Z. Mid-Term Outcome after Tricuspid Valve Replacement. Braz J Cardiovasc Surg 2020; 35:644-653. [PMID: 33118728 PMCID: PMC7598977 DOI: 10.21470/1678-9741-2019-0215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the mid-term survival rate after tricuspid valve replacement (TVR). Methods We retrospectively studied 110 consecutive patients who underwent TVR from January 2007 to November 2017. A survival analysis was performed with the Kaplan-Meier method and the log-rank test. Results The median survival was 65.81 months. Mean age was 50 (range 39 to 59) years. Forty-eight patients (43.6%) were male, and 62 patients (56.4%) were female. Most of the patients (78.5%) were categorized into the New York Heart Association (NYHA) functional classes III/IV. Seventy-two patients (65.5%) had isolated TVR. Six-three patients (57.3%) had previously undergone heart surgery. The Kaplan-Meier survival rates at one year, three years, and five years were 59.0%±5%, 52.0%±6%, and 48.0%±6%, respectively. A Cox regression analysis demonstrated that the risk factors for mid-term mortality were advanced NYHA class (hazard ratio [HR] 2.430, 95% confidence interval [CI] 1.099-5.375, P=0.028), need for continuous renal replacement therapy (CRRT) treatment (HR 3.121, 95% CI 1.610-6.050, P=0.001), and need for intra-aortic balloon pump (IABP) treatment (HR 3.356, 95% CI 1.072-10.504, P=0.038). Conclusion In TVR, impaired cardiac function before the operation and a need for CRRT or IABP treatment after the operation is independently associated with increased mid-term mortality.
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Affiliation(s)
- Yanmei Cheng
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiothoracic Surgery ICU Guangzhou People's Republic of China Department of Cardiothoracic Surgery ICU, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shaoyan Mo
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiopulmonary Bypass Guangzhou People's Republic of China Department of Cardiopulmonary Bypass, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Keke Wang
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiopulmonary Bypass Guangzhou People's Republic of China Department of Cardiopulmonary Bypass, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Rui Fan
- The First Affiliated Hospital of Sun Yat-sen University Department of Echocardiography Guangzhou People's Republic of China Department of Echocardiography, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yunqi Liu
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiac Surgery Guangzhou People's Republic of China Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Si Li
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiothoracic Surgery ICU Guangzhou People's Republic of China Department of Cardiothoracic Surgery ICU, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xi Zhang
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiac Surgery Guangzhou People's Republic of China Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shengli Yin
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiac Surgery Guangzhou People's Republic of China Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yingqi Xu
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiac Surgery Guangzhou People's Republic of China Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Baiyun Tang
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiothoracic Surgery ICU Guangzhou People's Republic of China Department of Cardiothoracic Surgery ICU, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhongkai Wu
- The First Affiliated Hospital of Sun Yat-sen University Department of Cardiac Surgery Guangzhou People's Republic of China Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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7
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Hirata K, Tengan T, Wake M, Takahashi T, Ishimine T, Yasumoto H, Nakasu A, Mototake H. Bioprosthetic tricuspid valve stenosis: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5532106. [PMID: 31367735 PMCID: PMC6764547 DOI: 10.1093/ehjcr/ytz110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 06/19/2019] [Indexed: 11/14/2022]
Abstract
Background Bioprosthetic tricuspid valve stenosis is a late sequela of tricuspid valve replacement (TVR); however, detailed information regarding its clinical picture is lacking. Case summary Thirty-one patients with bioprosthetic TVR (mean age: 60.5 ± 16.6 years, male/female: 11/20) were followed-up for 79.5 ± 49.1 months (14–188 months). Eleven patients developed bioprosthetic tricuspid valve stenosis (mean tricuspid gradient >5 mmHg) at a median interval of 96 months (interquartile range: 61–114 months). The mean tricuspid gradient at the time of tricuspid valve stenosis diagnosis was 10.9 ± 3.9 mmHg. Although the mid-term tricuspid valve stenosis-free survival was favourable (92.4% at 60 and 78.7% at 84 months), it had declined steeply to 31.5% by 120 months. Ten out of 11 tricuspid valve stenosis patients showed signs of right heart failure (RHF) as manifested by oedema and elevated jugular venous pressure, requiring moderate-to-high doses of diuretics. Diastolic rumble was audible in 10 patients. Five of the 11 tricuspid valve stenosis patients required redo TVR as a result of refractory RHF. Examination of the five excised bioprostheses showed pannus in four, fusion of the commissure in three, native valve attachment in two, and sclerosis in one. Detailed clinical pictures and pathology of the explanted valves in three cases that underwent surgery are presented in this case series. Discussion Bioprosthetic tricuspid valve stenosis is not uncommon after 8 years. Tricuspid valve replacement performed at the second surgery was associated with a higher incidence of bioprosthetic tricuspid valve stenosis.
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Affiliation(s)
- Kazuhito Hirata
- Division of Cardiology, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, Japan
| | - Toshiho Tengan
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, Japan
| | - Minoru Wake
- Division of Cardiology, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, Japan
| | - Takanori Takahashi
- Division of Cardiology, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, Japan
| | - Toru Ishimine
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, Japan
| | - Hiroshi Yasumoto
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, Japan
| | - Akio Nakasu
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, Japan
| | - Hidemitsu Mototake
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281 Miyazato, Uruma City, Okinawa, Japan
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Moutakiallah Y, Aithoussa M, Atmani N, Seghrouchni A, Moujahid A, Hatim A, Asfalou I, Lakhal Z, Boulahya A. Reoperation for isolated rheumatic tricuspid regurgitation. J Cardiothorac Surg 2018; 13:104. [PMID: 30286778 PMCID: PMC6172749 DOI: 10.1186/s13019-018-0793-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/25/2018] [Indexed: 11/17/2022] Open
Abstract
Background The reoperation for isolated tricuspid regurgitation in rheumatic population is rare and still unclear and controversial because of the rarity of publications. The aim of this study was to analyze short and long-term results and outcome of tricuspid valve surgery after left-sided valve surgery in rheumatic patients. Methods Twenty six consecutive rheumatic patients who underwent isolated tricuspid valve surgery after left-sided valve surgery between January 2000 and January2017 were retrospectively registered in the study. The mean age was 48.2 ± 8.6 years with 8.3% as sex-ratio (M/F). EuroSCORE was 6.1 ± 5 (range 2.5 to 24.1). The mechanism of tricuspid regurgitation was functional and organic in respectively 14 (53.8%) and 12 cases (46.2%). Ten patients (38.5%) had previous tricuspid valve repair. Surgery consisted of 15 ring annuloplasty and 11 tricuspid valve replacement (5 bioprostheses and 6 mechanical prostheses). Follow-up was 96.1% complete, with a mean follow-up of 55.6 ± 38.8 months (range 1 to 165). Results The operative mortality rate was 15.4% (n = 4) and the cumulative survival at 1, 5 and 10 years was respectively 80% ± 8%, 75.6% ± 8.7% and 67.2% ± 11.1% with no significant difference at 8 years between tricuspid valve replacement (80% ± 12.6%) and repair (57.6% ± 16.1%) (p = 0.5). Multivariable Cox regression analysis revealed that ascites (HR, 5.8; p = 0.01), and right ventricular dysfunction (HR, 0.94; p = 0.001) were predictors of major adverse cardiac events. There were no recurrence of tricuspid regurgitation and no structural or non-structural deterioration of valvular prostheses. Conclusion The reoperation of rheumatic tricuspid regurgitation should be considered before the installation of complications such as right ventricular dysfunction and major signs of right heart failure. Despite the superiority of repair techniques, tricuspid valve replacement should not be banished.
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Affiliation(s)
- Younes Moutakiallah
- Cardiac surgery department, Mohammed V teaching military hospital, Hay Riyad, PB 10100, Rabat, Morocco. .,Faculty of medicine and pharmacy, Mohammed V university, Rabat, Morocco.
| | - Mahdi Aithoussa
- Cardiac surgery department, Mohammed V teaching military hospital, Hay Riyad, PB 10100, Rabat, Morocco.,Faculty of medicine and pharmacy, Mohammed V university, Rabat, Morocco
| | - Noureddine Atmani
- Cardiac surgery department, Mohammed V teaching military hospital, Hay Riyad, PB 10100, Rabat, Morocco.,Faculty of medicine and pharmacy, Mohammed V university, Rabat, Morocco
| | - Aniss Seghrouchni
- Cardiac surgery department, Mohammed V teaching military hospital, Hay Riyad, PB 10100, Rabat, Morocco.,Faculty of medicine and pharmacy, Mohammed V university, Rabat, Morocco
| | - Azeddine Moujahid
- Intensive care of cardiac surgery, Mohammed V teaching military hospital, Rabat, Morocco.,Faculty of medicine and pharmacy, Mohammed V university, Rabat, Morocco
| | - Abdedaïm Hatim
- Intensive care of cardiac surgery, Mohammed V teaching military hospital, Rabat, Morocco.,Faculty of medicine and pharmacy, Mohammed V university, Rabat, Morocco
| | - Iliyasse Asfalou
- Cardiology department, Mohammed V teaching military hospital, Rabat, Morocco.,Faculty of medicine and pharmacy, Mohammed V university, Rabat, Morocco
| | - Zouhair Lakhal
- Cardiology department, Mohammed V teaching military hospital, Rabat, Morocco.,Faculty of medicine and pharmacy, Mohammed V university, Rabat, Morocco
| | - Abdelatif Boulahya
- Cardiac surgery department, Mohammed V teaching military hospital, Hay Riyad, PB 10100, Rabat, Morocco.,Faculty of medicine and pharmacy, Mohammed V university, Rabat, Morocco
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Zafar F, Hinton RB, Moore RA, Baker RS, Bryant R, Narmoneva DA, Taylor MD, Morales DL. Physiological Growth, Remodeling Potential, and Preserved Function of a Novel Bioprosthetic Tricuspid Valve: Tubular Bioprosthesis Made of Small Intestinal Submucosa-Derived Extracellular Matrix. J Am Coll Cardiol 2015; 66:877-88. [PMID: 26293756 DOI: 10.1016/j.jacc.2015.06.1091] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prosthetic valves currently used in children lack the ability to grow with the patient and often require multiple reoperations. Small intestinal submucosa-derived extracellular matrix (SIS-ECM) has been used successfully as a patch for repair in various tissues, including vessels, valves, and myocardium. OBJECTIVES This study sought to assess the remodeling potential of a tubular tricuspid valve (TV) bioprosthesis made of SIS-ECM by evaluating its growth, structure, and function in a growing ovine model. METHODS A total of 12 3-month-old lambs were studied for a period of 3 or 8 months. SIS-ECM TVs were placed in 8 lambs; conventional bioprosthetic valves and native valves (NV) were studied as controls. All lambs underwent serial echocardiography, measuring annulus diameter and valve and right ventricular function. RESULTS The SIS-ECM valves demonstrated an incremental increase in annular diameter similar to NV. SIS-ECM valve function was normal in 7 of 8; 1 valve had severe regurgitation due to a flail leaflet. Explanted SIS-ECM valves approximated native tissue in gross appearance. Histopathology demonstrated migration of resident mesenchymal cells into the scaffold and trilaminar ECM organization similar to an NV, without inflammation or calcification at 8 months. Ex vivo mechanical testing of SIS-ECM valve tissue showed normalization of the elastic modulus by 8 months. CONCLUSIONS In an ovine model, tubular SIS-ECM TV bioprostheses demonstrate "growth" and a cell-matrix structure similar to mature NVs while maintaining normal valve function. The SIS-ECM valve may provide a novel solution for TV replacement in children and adults.
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Affiliation(s)
- Farhan Zafar
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
| | - Robert B Hinton
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Ryan A Moore
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - R Scott Baker
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Roosevelt Bryant
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Daria A Narmoneva
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio
| | - Michael D Taylor
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - David L Morales
- Division of Pediatric Cardiothoracic Surgery, The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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10
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Morimoto N, Matsushima S, Aoki M, Henmi S, Nishioka N, Murakami H, Honda T, Nakagiri K, Yoshida M, Mukohara N. Long-term results of bioprosthetic tricuspid valve replacement: an analysis of 25 years of experience. Gen Thorac Cardiovasc Surg 2012; 61:133-8. [DOI: 10.1007/s11748-012-0190-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
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11
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Garatti A, Nano G, Bruschi G, Canziani A, Colombo T, Frigiola A, Martinelli L, Menicanti L. Twenty-five year outcomes of tricuspid valve replacement comparing mechanical and biologic prostheses. Ann Thorac Surg 2012; 93:1146-53. [PMID: 22342993 DOI: 10.1016/j.athoracsur.2011.12.031] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 12/06/2011] [Accepted: 12/06/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Tricuspid valve replacement (TVR) has historically been associated with high mortality and morbidity, and current knowledge of long-term results of TVR is limited. This study reviewed our experience from a consecutive series at 2 institutions. METHODS Ninety patients (65 women [72%]; mean age, 53.8 ± 14.2 years; mean body surface area, 1.6 ± 0.2 m(2)) underwent TVR between January 1980 and December 2005. The etiology was secondary to left-heart valve disease in 56 patients (62%), degenerative disease in 16 (18%), Ebstein anomaly in 7 (8%), and endocarditis in 11 (12%). Seventy patients (78%) were in New York Heart Association class III or IV. Sixty patients (67%) underwent redo procedures. TVR was with a mechanical valve in 46 patients (51%) and a biologic prosthesis in 44 (49%). RESULTS The overall operative mortality was 17.7% (16 patients). During follow-up, 16 of the 74 survivors died. Kaplan-Meier survival at 5, 10, and 15 years was, respectively, 72%, 65%, and 63%. During follow-up, 16 patients (21.6%) underwent reoperation; among them, 8 with a mechanical valve underwent reoperation for tricuspid valve thrombosis and 6 with a biologic prosthesis for tricuspid valve deterioration. However, freedom from reoperation at 5 and 10 years was similar between mechanical (86% and 76%) and bioprostheses (97% and 83%). All 16 patients survived the reoperation. CONCLUSIONS The present experience suggests that the type of implanted prosthesis in the tricuspid position does not affect early and long-term outcomes or the reoperation rate. Timely referral before end-stage cardiac impairment develops could determine further outcomes improvement.
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Affiliation(s)
- Andrea Garatti
- Department of Cardiovascular Disease E. Malan, Cardiac Surgery Unit, IRCCS Policlinico San Donato Hospital, Milan, Italy.
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Du Preez LJ, Le Roux P, Coetzee AR. Anaesthesia for transvenous transcatheter tricuspid valve-in-valve implantation. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2011. [DOI: 10.1080/22201173.2011.10872794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- LJ Du Preez
- Department of Anaesthesiology and Critical Care, Tygerberg Academic Hospital and Stellenbosch University, Parow
| | - P Le Roux
- Department of Anaesthesiology and Critical Care, Tygerberg Academic Hospital and Stellenbosch University, Parow
| | - AR Coetzee
- Department of Anaesthesiology and Critical Care, Tygerberg Academic Hospital and Stellenbosch University, Parow
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Hashimoto K. Beginning and development of surgery for acquired valvular heart disease in Japan. Gen Thorac Cardiovasc Surg 2009; 57:573-84. [PMID: 19908111 DOI: 10.1007/s11748-009-0459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Indexed: 11/30/2022]
Abstract
The initiation and development of surgery for acquired valvular heart disease in Japan was reviewed. The first series of attempts at closed valvular surgery were performed in 1951-1952 by collaboration between the brothers Tohru and Shigeru Sakakibara in patients with pulmonary or mitral stenosis. During the popularization of closed valvular surgery, open heart surgery under direct vision was successfully performed by Shigeru Sakakibara with cooling of the body in 1954 and by using cardiopulmonary bypass (CPB) in 1956. With the development of CPB and artificial heart valves, closed valvular heart surgery was replaced by open surgery, which expanded rapidly during the 1960s and 1970s. Along with the serial introduction and improvement of mechanical vales thereafter, bioprosthetic valves were also introduced and were adopted for certain patients. Use of bioprosthetic valves in the aortic position exceeded 50% in 2005, along with the increase of elderly patients. Although trials of mitral valve plasty for mitral regurgitation were first done during the 1950s to 1960s in Japan, interest in valve plasty only increased during the late 1970s. Considering the patient's quality of life and the long-term results, mitral valve plasty became the major procedure (exceeding valve replacement) from 2004. In 2002, the Guideline for Surgical and Interventional Treatment of Valvular Heart Disease was published by a joint committee of the relevant academic societies, and it has made an important contribution to improving surgical outcomes.
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Affiliation(s)
- Kazuhiro Hashimoto
- Department of Cardiac Surgery, Jikei University School of Medicine, Nishishinbashi, Minato-ku, Tokyo, Japan.
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Oda T, Kato S, Tayama E, Fukunaga S, Akashi H, Aoyagi S. Pannus overgrowth after mitral valve replacement with a Carpentier-Edwards pericardial bioprosthesis. J Artif Organs 2009; 12:55-7. [DOI: 10.1007/s10047-008-0445-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 11/27/2008] [Indexed: 11/28/2022]
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Bartlett HL, Atkins DL, Burns TL, Engelkes KJ, Powell SJ, Hills CB, Moller JH. Early Outcomes of Tricuspid Valve Replacement in Young Children. Circulation 2007; 115:319-25. [PMID: 17200445 DOI: 10.1161/circulationaha.106.618652] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early outcomes after tricuspid valve replacement in young children are ill defined. The experience of the Pediatric Cardiac Care Consortium (45 centers, 1984 to 2002) was reviewed to evaluate the results of tricuspid valve replacement in children <6 years of age. METHODS AND RESULTS Ninety-seven patients who underwent initial tricuspid valve replacement are included in the present analysis. The most frequent cardiac diagnoses were Ebstein's anomaly (40%), pulmonary atresia (11%), and tetralogy of Fallot (8%). Age at tricuspid valve replacement was 2.9+/-1.7 years (mean+/-SD). Mean patient weight was 12.7+/-6.1 kg. The major outcome was survival to discharge. Associations among age, diagnosis, valve type/size, and outcome were evaluated through the use of chi2 analysis and logistic regression model fitting approaches. Hospital mortality was 26% and was very high (64%) in patients <1 year of age. A large size-to-weight ratio was the strongest predictor of mortality based on multivariable analysis (P<0.001). Mortality was 54% for patients with a size-to-weight ratio >2.5. Other complications included heart block requiring a pacemaker (13%) and thrombosis (5%). Pacemaker implantation was associated with the use of a mechanical valve (23% versus 6% bioprosthetic valve; P=0.01) CONCLUSIONS Tricuspid valve replacement in young children is associated with high mortality, especially in infants <1 year of age. Surgical options other than tricuspid valve replacement such as transplantation may need to be considered in infants.
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Affiliation(s)
- Heather L Bartlett
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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Chang BC, Lim SH, Yi G, Hong YS, Lee S, Yoo KJ, Kang MS, Cho BK. Long-Term Clinical Results of Tricuspid Valve Replacement. Ann Thorac Surg 2006; 81:1317-23, discussion 1323-4. [PMID: 16564264 DOI: 10.1016/j.athoracsur.2005.11.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 10/29/2005] [Accepted: 11/03/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tricuspid valve replacement (TVR) has been performed with mechanical or bioprosthetic valves. However, the relative advantages of the two types are incompletely known. METHODS Between 1978 and 2003, we performed 138 TVR (35 bioprosthetic, 103 mechanical) in 125 patients (50 men, 75 women), with a mean age of 43.7 +/- 16.6 years. The diseases that required TVR were rheumatic (94), prosthetic valve failure (14), congenital (14), infective endocarditis(5), isolated tricuspid regurgitation (4), and miscellaneous conditions (7). The operations included the following: isolated TVR (41), double valve replacement (58), and triple valve replacement (39). The follow-up rate was 98.3%, and cumulative follow-up was 828.5 patient-years. RESULTS There were 22 in-hospital deaths (17.6%) and 13 (10.4%) late deaths. Fourteen patients required additional operations. There were 33 postoperative valve-related events including 11 thromboembolisms and 3 bleeding episodes. Kaplan-Meier survival for the entire group at 15 years was 73.8 +/- 8.5% (bioprosthetic: 70.2 +/- 10.4%, mechanical: 66.0 +/- 19.4%). At 15 years, freedom from reoperation was 66.3 +/- 9.4% (bioprosthetic: 55.1 +/- 13.8%, mechanical: 86.0 +/- 6.2%) and freedom from valve-related events was 49.9 +/- 8.0%. The linearized incidence of valve thrombosis was 1.28%/patient-year (bioprosthetic: 0, mechanical: 1.92), anticoagulation-related bleeding was 0.37%/patient-year (mechanical: 0.54), reoperation was 1.71%/patient-year (bioprosthetic: 2.68, mechanical: 1.25), and valve-related events were 4.33%/patient-year (bioprosthetic: 3.83, mechanical: 4.6). CONCLUSIONS Both bioprosthetic and mechanical valves revealed similar long-term outcomes. However, findings suggest that greater care is needed to prevent valve thrombosis in mechanical valves in the early postoperative period, and there is a greater chance for reoperation in bioprosthetic valves.
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Affiliation(s)
- Byung-Chul Chang
- Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Bernal JM, Gutiérrez-Morlote J, Llorca J, San José JM, Morales D, Revuelta JM. Tricuspid Valve Repair: An Old Disease, a Modern Experience. Ann Thorac Surg 2004; 78:2069-74; discussion 2074-5. [PMID: 15561038 DOI: 10.1016/j.athoracsur.2004.06.067] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND We review our experience in patients who required surgical correction of tricuspid valve disease with concomitant disease of the mitral or aortic valve, or both, operated on between 1987 and 1999. METHODS We studied 232 consecutive patients (mean age, 59.8 years) followed for a mean of 6.8 years (range, 2 to 12 years). All patients were investigated by means of Doppler echocardiography, with hemodynamic studies in 135. Median tricuspid insufficiency was 3+. The cause was rheumatic heart disease in 186 patients and degenerative in 46. All patients underwent suture annuloplasty (De Vega or segmental) at the time of mitral or aortic valve surgery. Tricuspid lesions were functional in 128 patients and organic in 104. RESULTS The hospital and late mortality rates were 8.1% and 23.3%, respectively. These figures were independent of the type of annuloplasty performed. Predictors of hospital mortality were biologic prosthesis, renal insufficiency, time of cardiopulmonary bypass, and use of inotropic drugs. Predictors of late mortality were age older than 60 years, left ventricular ejection fraction less than 0.50, and New York Heart Association functional class IV. At 12 years, the actuarial survival rate was 50.5% +/- 6.1%, and the actuarial curve free from reoperation 75.7% +/- 7.3%. The actuarial curve for freedom from valve-related complication was 39.0% +/- 6.3% at 11 years. CONCLUSIONS Despite the use of modern technologic advances in the diagnosis and treatment of valvular hear disease, tricuspid insufficiency continues to be a poor prognostic factor in patients with concomitant disease of the mitral or aortic valve, or both.
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Affiliation(s)
- José M Bernal
- Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, Universidad de Cantabria, Santander, Spain.
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Rizzoli G, Vendramin I, Nesseris G, Bottio T, Guglielmi C, Schiavon L. Biological or mechanical prostheses in tricuspid position? a meta-analysis of intra-institutional results. Ann Thorac Surg 2004; 77:1607-14. [PMID: 15111151 DOI: 10.1016/j.athoracsur.2003.10.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2003] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tricuspid valve replacement (TVR) is an uncommon procedure. The use of biological vs mechanical prostheses in TVR has pros and cons. Therefore, we debate the choice between the different types of valves by means of a meta-analysis of studies of the last decade. METHODS The heading "tricuspid valve replacement and (bio* or mec*)" was used to retrieve studies from Medline, Current Contents, and Embase. Eight out of 11 studies met the preset strict criteria: intra-institutional comparison of results of biological or mechanical TVR. Survival of hospital-discharged patients was recalculated to reduce the effect of unbalanced perioperative risk factors on overall survival. Hazard ratio was obtained from actuarial survival graphics comparison and at-risk groups, according to the method described by Parmar. If missing, the number of patients at risk was approximated assuming constant and noninformative censoring. Hazard pooling was done according to study heterogeneity. Bioprostheses were assumed as the gold standard and mechanical prostheses assumed as the challenging device. Therefore, a hazard more than 1 pointed to a higher risk of mechanical prostheses. Our 1998 study was updated for this analysis. RESULTS In this study, 1,160 prostheses and 6,046 follow-up years were analyzed. The pooled survival hazard ratio of mechanical prostheses versus bioprostheses was 1.07 (0.84 to 1.35, p = 0.60). The pooled freedom from reoperation hazard ratio was 1.24 (0.67 to 2.31, p = 0.67). Pooled survival differences were trivial, favoring mechanical prostheses at 1 (-0.04%) and 15 years (-1.1%) and favoring bioprostheses (+1.8%) at 10 years. CONCLUSIONS There is not a gold standard in tricuspid prostheses replacement. Prosthetic choice is left to the surgeon's clinical judgment, taking into consideration each patient's characteristics and needs.
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Affiliation(s)
- Giulio Rizzoli
- Istituto di Chirurgia Cardiovascolare, Università di Padova, Padua, Italy.
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Rizzoli G, Bottio T, Thiene G, Toscano G, Casarotto D. Long-term durability of the Hancock II porcine bioprosthesis. J Thorac Cardiovasc Surg 2003; 126:66-74. [PMID: 12878940 DOI: 10.1016/s0022-5223(02)73618-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Survival and prosthetic complications of patients receiving the Hancock II second-generation bioprosthesis (Medtronic, Inc, Minneapolis, Minn) in the aortic, mitral, mitral-aortic, and tricuspid positions were analyzed at 15 years' follow-up. METHODS Between May 1983 and December 1993, 212 patients (104 men and 108 women; mean age, 63 +/- 9 years; age range, 29-81 years) received 66 aortic, 114 mitral, 26 mitral-aortic, and 6 tricuspid Hancock II valves. Thirty-one percent of patients had previous valve operations, 15% had concomitant cardiac procedures, and 87% were in New York Heart Association class III or IV. Follow-up included 1704 patient-years and was 98% complete, with a median of 9 patient-years (range, 0.013-17.4 years). Forty-six patients were at risk at 14 to 15 years, and 30 were at risk after 15 years. RESULTS One hundred twenty-two (57%) of 212 patients died, 20 of them perioperatively. Fifteen-year actuarial Kaplan-Meier survival was 35.2% +/- 3.8%, and freedom from valve-related mortality was 84% +/- 3.5%, with no difference on the basis of position or age (<65 or >or=65 years). Percentages for freedom from thromboembolism, anticoagulant-related hemorrhage, endocarditis, and paravalvular leak were, respectively, 78.2% +/- 4%, 83.5% +/- 3.6%, 95.7% +/- 2%, and 97.3% +/- 1.4%, with no significant difference between the aortic and mitral positions. Freedom from structural valve deterioration was 71.8% +/- 5.6%: 88.9% +/- 6.2% in the aortic position versus 59.5% +/- 3.9% in the mitral position (P =.01) and 64.3% +/- 3% in the mitral-aortic position. In patients younger than 65 years, actual freedom from structural valve deterioration was less than that seen in older patients (84.5% +/- 3.5% vs 95% +/- 3.0%) and was better in the aortic versus the mitral position (92% +/- 4.5% vs 82% +/- 4.2%). CONCLUSION The Hancock II porcine valve showed excellent 15-year durability. We recommend its use in patients 65 years of age, as well as in younger patients undergoing aortic replacement.
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Affiliation(s)
- Giulio Rizzoli
- Department of Cardiovascular Surgery, University of Padua Medical School, Italy.
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Kaplan M, Kut MS, Demirtas MM, Cimen S, Ozler A. Prosthetic replacement of tricuspid valve: bioprosthetic or mechanical. Ann Thorac Surg 2002; 73:467-73. [PMID: 11845861 DOI: 10.1016/s0003-4975(01)03128-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tricuspid valve replacement is one of the most challenging operations in cardiac surgery. Selection of the suitable prosthesis is still debatable. METHODS In our institution, between January 1980 and December 2000, 129 tricuspid valve replacements were performed in 122 patients (14.7%). Bioprosthetic valves were used in 32 patients, whereas 97 patients had mechanical valve implantation. Twenty-two percent of replacements were done on men. Mean age was 35.27+/-11.56 years. In all patients, initially an annuloplasty technique was tried. Tricuspid valve replacement was performed when annuloplasty was not sufficient. In most of the cases, tricuspid valve interventions were done under cardiopulmonary bypass and on a beating heart. RESULTS Early mortality was 24.5%. Patients were followed for 2 to 228 months. Seven patients underwent reoperation because of tricuspid valve dysfunction (7.6%). Nine patients died during the follow-up period. Late mortality was 9.7%. Actuarial estimates of survival in 20 years of follow-up for all tricuspid prosthetic valves, mechanical valves, and bioprosthetic valves were 65.1%+/-9.3%, 68.3%+/-10.6%, and 54.8%+/-12.1%, respectively. For the bioprosthetic valve group, freedom from structural valve degeneration was 90%+/-5.5%; for the mechanical valve group, freedom from deterioration, endocarditis, and leakage was 97.8%+/-4.2%, and freedom from thromboembolism was 92.6%+/-6.9%. CONCLUSIONS We found that there was no statistically significant difference between the two groups in terms of early mortality, re-replacement, and midterm mortality (p > 0.05). Nevertheless, we recommend low profile modern bileaflet mechanical valves for prosthetic replacement of the tricuspid valve, due to their favorable hemodynamic characteristics and durability.
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Affiliation(s)
- Mehmet Kaplan
- Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
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Machida H, Ishibashi-Ueda H, Nakano K, Sasako Y, Kobayashi J, Bando K, Minatoya K, Imamura H, Kitamura S. A morphologic study of Carpentier-Edwards pericardial xenografts in the mitral position exhibiting primary tissue failure in adults in comparison with Ionescu-Shiley pericardial xenografts. J Thorac Cardiovasc Surg 2001; 122:649-55. [PMID: 11581594 DOI: 10.1067/mtc.2001.116202] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to investigate the durability and mechanism of the Carpentier-Edwards pericardial xenograft in the mitral position in comparison with that of the Ionescu-Shiley pericardial xenograft. METHODS A total of 284 patients who received the Ionescu-Shiley pericardial xenograft in the mitral position between 1980 and 1984 and 84 patients who received the Carpentier-Edwards pericardial xenograft in the mitral position between 1984 and 1999 were included in the study. The freedom from reoperation rates for both graft types were determined. For morphologic study, the pathologic findings of 23 valves of 123 explanted Ionescu-Shiley pericardial xenografts with structural valve deterioration, nonstructural valve deterioration, or both were determined and compared with those of 20 explanted Carpentier-Edwards pericardial xenografts with structural valve deterioration, nonstructural valve deterioration, or both. Each pathologic finding was graded and assigned a score. Both types were matched for age at reoperation (50-75 years) and duration of valve function (8-11 years). RESULTS Freedom from reoperation caused by structural valve deterioration, nonstructural valve deterioration, or both was significantly better for Carpentier-Edwards pericardial xenografts than for Ionescu-Shiley pericardial xenografts at 8 years after the operation (Carpentier-Edwards pericardial xenografts: 91.3% vs Ionescu-Shiley pericardial xenografts: 71.9%, P =.0061), but it was similar for both types at 12 years (Carpentier-Edwards pericardial xenografts: 43.6% vs Ionescu-Shiley pericardial xenografts: 43.6%, P =.2865). No severe leaflet tears were seen among Carpentier-Edwards pericardial xenografts. The mean area percentage of tissue overgrowth was 15.3% in Carpentier-Edwards pericardial xenografts and 3.4% in Ionescu-Shiley pericardial xenografts (P =.0001). The mean calcification area percentage was 13.6% in Carpentier-Edwards pericardial xenografts and 31.5% in Ionescu-Shiley pericardial xenografts (P =.0001). CONCLUSIONS Tissue overgrowth on the atrial surface, ventricular surface, or both was the cause of structural valve deterioration, nonstructural valve deterioration, or both of Carpentier-Edwards pericardial xenografts in adults. This was different from Ionescu-Shiley pericardial xenograft failure, which resulted from severe calcification and leaflet tears. Organized thrombi on cusps, in addition to valve design, may have contributed to such tissue overgrowth on Carpentier-Edwards pericardial xenografts.
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Affiliation(s)
- H Machida
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
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Ohata T, Kigawa I, Tohda E, Wanibuchi Y. Comparison of durability of bioprostheses in tricuspid and mitral positions. Ann Thorac Surg 2001; 71:S240-3. [PMID: 11388195 DOI: 10.1016/s0003-4975(01)02557-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Few reports have assessed differences in the durability of mitral and tricuspid bioprostheses after simultaneous implantation of the same bioprosthesis in both positions. We investigated the long-term outcome after simultaneous mitral valve replacement (MVR) and tricuspid valve supraannular implantation (TVSI) with the Carpentier-Edwards bioprostheses in patients with severe tricuspid regurgitation and advanced mitral valve disease. METHODS Between 1982 and 1998, 37 patients in our hospital underwent MVR and TVSI with Carpentier-Edwards bioprostheses. The mean age of the patients was 55+/-11 years. The average postoperative follow-up was 7.9+/-4.5 years after surgery (range 0 to 14.6 years, 315.1 patient-years). The follow-up rate was 100%. We evaluated the actuarial survival rate, the actuarial freedom from structural valve deterioration (SVD) and reoperation, and postoperative complications. RESULTS The overall actuarial survival rate at 13 years after the operation was 69%+/-31%. The actuarial freedom from SVD and reoperation in the mitral and tricuspid positions were 78+/-22 and 100% and 70+/-30 and 90%+/-10% (p = 0.03), respectively. No patient had systemic or pulmonary thromboembolism, or complications associated with fatal arrhythmia. CONCLUSIONS These results suggest that the bioprostheses in the tricuspid position yield significantly better long-term results than those in the mitral position after simultaneous MVR and TVSI.
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Affiliation(s)
- T Ohata
- Division of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
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Tayama E, Kawano H, Takaseya T, Hiratsuka R, Oda T, Hayashida N, Fukunaga S, Aoyagi S. Triple valve replacement with bileaflet mechanical valves: is the mechanical valve the proper choice for the tricuspid position? JAPANESE CIRCULATION JOURNAL 2001; 65:257-60. [PMID: 11316118 DOI: 10.1253/jcj.65.257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A more durable mechanical valve may be a better choice for the tricuspid position than a bioprosthesis when the patient already has mechanical prosthesis in the left side of the heart. Eleven cases of triple valve replacement (total follow-up period, 49.5 patient years), all with mechanical valves, are reviewed to assess optimal valve selection. Nine patients had undergone a total of 12 previous cardiac surgeries. Three patients died in hospital (27.3%), but there were no late deaths among the survivors. Two cases of valve thrombosis in the tricuspid position occurred (linearized incidence: 4.04%/patient years) and 1 of these required reoperation. Because of this high incidence of valve thrombosis, the bileaflet mechanical valve is not considered to be the best choice. Even if mechanical valves are implanted in the left side of the heart, a bioprosthesis may be a better choice at the tricuspid position.
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Affiliation(s)
- E Tayama
- Department of Surgery, Kurume University School of Medicine, Japan.
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Tanaka M, Ohata T, Fukuda S, Kigawa I, Yamashita Y, Wanibuchi Y. Tricuspid valve supra-annular implantation in adult patients with Ebstein's anomaly. Ann Thorac Surg 2001; 71:582-6. [PMID: 11235710 DOI: 10.1016/s0003-4975(00)02282-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Tricuspid valve supra-annular implantation (TVSI) has been performed for adult patients with Ebstein's anomaly at our hospital for several decades. TVSI is characterized by reliable reduction of tricuspid annulus size without affecting the conduction system; by prevention of residual tricuspid regurgitation (RTR) through preservation of the native tricuspid valve; and by implantation of the bioprosthesis at a supra-annular site. METHODS Ten adult patients with Ebstein's anomaly underwent TVSI. The right ventricular diameter and residual tricuspid regurgitation were evaluated by echocardiography preoperatively, at discharge, 1 year after the operation, and over the long term (12.4 +/- 5.5 years). Actuarial survival rate, actuarial freedom from structural valve deterioration rate, and postoperative occurrence of arrhythmia were also evaluated. RESULTS The actuarial survival rate at 19 years was 76 +/- 15%. Tricuspid regurgitation disappeared in 8 patients just after operation. Right ventricular diameter was significantly smaller at discharge than preoperatively (63 +/- 11 vs 37 +/- 9, p < 0.01), and there were no significant differences between values at discharge and at follow-up. The actuarial freedom from structural valve deterioration rate and the reoperation rate were both 100%. There were no fatal complications related to arrhythmia or thromboembolism. CONCLUSIONS TVSI is useful for adult patients with Ebstein's anomaly. The absence of complications related to fatal arrhythmia and thromboembolism, good durability of the bioprosthesis, and a simple operative procedure are merits of this therapy.
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Affiliation(s)
- M Tanaka
- Division of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
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Mangoni AA, DiSalvo TG, Vlahakes GJ, Polanczyk CA, Fifer MA. Outcome following isolated tricuspid valve replacement. Eur J Cardiothorac Surg 2001; 19:68-73. [PMID: 11163563 DOI: 10.1016/s1010-7940(00)00598-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES The clinical outcome of isolated tricuspid valve replacement is not well defined because this procedure is usually performed concomitantly with other valve surgery. METHODS We retrospectively studied the short and long-term outcome of 15 consecutive patients (six men and nine women, aged 61+/-3 years) undergoing isolated tricuspid valve replacement from 1984 to 1996. The cause of valve dysfunction was rheumatic heart disease in 12 patients, healed endocarditis in two patients, and sarcoidosis in one patient. The tricuspid valve was stenotic in one patient, regurgitant in eight patients, and both stenotic and regurgitant in six patients. A St. Jude Medical prosthesis was placed in eight patients, Carpentier-Edwards in five patients, and Björk-Shiley and Starr-Edwards in one patient each. RESULTS The median survival was only 1.2 years. Three patients (20%) died < or =30 days after the surgery or before discharge, and six other patients (40%) died within 3 years of surgery. Anasarca was the only predictor of short-term mortality (P=0.03), while the predictors of long-term mortality were anemia (P=0.01), rheumatic heart disease (P=0.04), previous stroke (P=0.04), and previous mitral valve surgery (P=0.04). CONCLUSIONS Isolated tricuspid valve replacement is characterized by a poor short and long-term outcome.
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Affiliation(s)
- A A Mangoni
- Department of Medicine (Cardiology Division), Massachusetts General Hospital and Harvard Medical School, MA, Boston, USA
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Nakano K, Ishibashi-Ueda H, Kobayashi J, Sasako Y, Yagihara T. Tricuspid valve replacement with bioprostheses: long-term results and causes of valve dysfunction. Ann Thorac Surg 2001; 71:105-9. [PMID: 11216727 DOI: 10.1016/s0003-4975(00)02149-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although the clinical performance of bioprostheses after valve replacement in the aortic and mitral position has been reported, little is known of the performance of tricuspid bioprostheses. The mechanism of bioprosthetic valve dysfunction after tricuspid valve replacement (TVR) is not clear. METHODS We reviewed 98 cases of TVR with bioprostheses. To clarify the causes of valve dysfunction, pathologic examination of the explanted valve at the reoperation was performed. RESULTS Actuarial survival at 18 years was 68.7% +/- 5.8%. There were 12 redo TVRs. In six of the 12 cases, isolated redo TVR was performed. In the other cases, concomitant cardiac procedures were performed. The causes of prosthetic valve dysfunction were pannus formation on the cusps of the right ventricle side (four cases), native valve attachment (two cases), pannus formation + native valve attachment (two cases), sclerotic change (one case), pannus formation + sclerotic change (one case), and native valve attachment + valve infection (one case). Freedom from reoperation, structural valve deterioration, and nonstructural dysfunction at 18 years was 62.7% +/- 10.7%, 96.0% +/- 2.9%, and 76.7% +/- 8.3%, respectively. CONCLUSIONS In our 18 years of experience, although the survival after TVR with bioprostheses is acceptable, the reoperation free rate is not satisfactory. Pannus formation on the cusps of the ventricular side seems to be a serious problem that causes bioprosthetic dysfunction in the tricuspid position.
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Affiliation(s)
- K Nakano
- Department of Cardiovascular Surgery and Pathology, National Cardiovascular Center, Suita, Osaka, Japan.
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Kawano H, Oda T, Fukunaga S, Tayama E, Kawara T, Oryoji A, Aoyagi S. Tricuspid valve replacement with the St. Jude Medical valve: 19 years of experience. Eur J Cardiothorac Surg 2000; 18:565-9. [PMID: 11053818 DOI: 10.1016/s1010-7940(00)00570-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The choice of the valve substitute in the tricuspid position remains controversial. A St. Jude Medical valve is a choice of valve substitute and its lower thrombogenicity and excellent hemodynamic performance have been reported even in the tricuspid position. However, little is known of the long-term durability of the St. Jude Medical valve in the tricuspid position. Our long-term experience of tricuspid valve replacement showed the higher thrombogenicity than we had expected, therefore, this study was done to reconsider our strategy for valve choice. METHODS This study reviewed 23 patient who underwent 25 tricuspid valve replacements with the St. Jude Medical valves from 1980 to 1997. The mean age was 40 years. Eleven patients (48%) were men. There were four in-hospital deaths (17%). The remaining 19 patients were all alive and followed from 2.2 to 19.0 years (mean 11.8 years). RESULTS The overall survival, including hospital mortality, was 83%, 10 and 15 years after surgery. Valve thrombosis occurred in six patients. Freedom from valve thrombosis was 78 and 70%, 10 and 15 years after surgery, respectively. The linearized rate of the valve thrombosis was 2.9%/patient-years. Six patients required reoperation. The mean interval to reoperation was 9.5 years. Freedom from reoperation was 83% and 75%, 10 and 15 years after surgery, respectively. The linearized rate of the reoperation was 2.8%/patient-years. No structural valve deterioration was found. Echocardiographic study showed that the function of the St. Jude Medical valve without valve-related complications was well maintained. CONCLUSIONS The higher thrombogenicity of the St. Jude Medical valve in the tricuspid position altered our choice of valve substitutes from the St. Jude Medical valve to a bioprosthesis which is lack of need for anticoagulant therapy except for juvenile patients who are able to maintain potent anticoagulant therapy.
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Affiliation(s)
- H Kawano
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan.
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Ohata T, Kigawa I, Yamashita Y, Wanibuchi Y. Surgical strategy for severe tricuspid valve regurgitation complicated by advanced mitral valve disease: long-term outcome of tricuspid valve supra-annular implantation in eighty-eight cases. J Thorac Cardiovasc Surg 2000; 120:280-3. [PMID: 10917943 DOI: 10.1067/mtc.2000.107486] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although annuloplasty has been the most commonly performed surgical modality for severe tricuspid regurgitation, tricuspid valve supra-annular implantation has been performed in our hospital for more than a decade. The aim of this study was to assess the long-term outcome of tricuspid valve supra-annular implantation in a subgroup of patients with severe tricuspid regurgitation, those who also had advanced mitral valve disease. METHODS Mitral valve replacement in conjunction with tricuspid valve supra-annular implantation was performed on 88 patients at our hospital between 1984 and 1998. The patients (mean age 57 +/- 11 years) were followed up for an average of 7.2 +/- 4.5 years after the operation (range 0-14 years); total follow-up was 643.1 patient-years. All patients except 2 (97.6%) were included in the follow-up. We evaluated the mortality, the cause of death, survival, the freedom from structural valve deterioration and reoperation, postoperative complications, and long-term echocardiographic findings. RESULTS Overall survival at 14 years was 69% +/- 7.7%. Freedom from structural valve deterioration at 14 years was 100% and from reoperation, 88% +/- 9. 4%. There were no instances of pulmonary thromboembolism or of complications associated with fatal arrhythmias. Echocardiography showed little residual tricuspid regurgitation, no atrophic and stenotic change in the native tricuspid valve, and no thrombus formation between native valve and the implanted bioprosthesis. CONCLUSIONS The procedure's simplicity, the good long-term durability of the bioprosthesis, and the absence of fatal arrhythmias and pulmonary thromboembolism indicate that tricuspid valve supra-annular implantation is a useful procedure for patients with severe tricuspid regurgitation complicated by advanced mitral valve disease.
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Affiliation(s)
- T Ohata
- Division of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan
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Hilton AK, Jaggers J, Mathew J. An unexpected flow abnormality. J Cardiothorac Vasc Anesth 2000. [DOI: 10.1053/cr.2000.5835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ohata T, Kigawa I, Wanibuchi Y. Difference in structural change in the Carpentier-Edwards pericardial valves implanted in the mitral and tricuspid positions. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:242-4. [PMID: 10824479 DOI: 10.1007/bf03218131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a 29-year-old patient with prosthetic valve dysfunction with severe calcific stenosis in the mitral position but no structural change in the tricuspid position after mitral valve replacement and tricuspid valve supra-annular implantation with same bioprostheses at the seven years before. The difference in structural change between the mitral position and the tricuspid position might be due mainly to the effect of mechanical stress on the cusps, rather than to any difference in serum calcium levels. However, some hormonal effect other than that of the parathyroid hormone on the systemic and pulmonary circulation might be related to the early progression in cusp calcification in the systemic circulation.
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Affiliation(s)
- T Ohata
- Division of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan
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Ratnatunga CP, Edwards MB, Dore CJ, Taylor KM. Tricuspid valve replacement: UK Heart Valve Registry mid-term results comparing mechanical and biological prostheses. Ann Thorac Surg 1998; 66:1940-7. [PMID: 9930473 DOI: 10.1016/s0003-4975(98)01183-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known of time-related outcome and comparative performance of biological and mechanical prostheses following tricuspid valve replacement (TVR). METHODS A retrospective UK Heart Valve Registry study (Jan 1, 1986 to June 30, 1997) identified 425 patients who underwent TVR. Two-hundred twenty-five (52.9%) received biological and 200 (47.1%) received mechanical valves. One-hundred sixty (38%), 158, and 76 had isolated, double, and triple valve replacements, respectively. The follow-up was 96% complete with a total of 1,585 patient-years. RESULTS Thirty-day mortality for TVR was 17.3% (73 deaths). One-, 5-, and 10-year survival rates were 72.2%, 59.9%, and 42.9%, respectively. Year of operation (p = 0.04), age (p = 0.04), and number of valves implanted (p = 0.0 3) predicted overall mortality. Age (p<0.001) and year of operation (p = 0.002) predicted overall survival. Thirty-day mortality for biological and mechanical prostheses was 18.8% and 15.6%, respectively. One-, 5-, and 10-year survival rates were 70.5%, 61.5%, and 47.7% for biological and 74.0%, 57.9%, and 33.9% for mechanical prostheses, respectively. Freedom from reoperation at 1 and 10 years was 98.7% and 97.4%. Freedom from death or reoperation was 71.2% at 1 year and 41.9% at 10 years. None of the above outcomes was significantly different between the type of valve prostheses. CONCLUSIONS TVR carries a high 30-day mortality and a poor longer term survival. No superiority could be identified for biological or mechanical prostheses in the tricuspid position for either survival or reoperation.
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Affiliation(s)
- C P Ratnatunga
- United Kingdom Heart Valve Registry, Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College School of Medicine, London, England
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Rizzoli G, De Perini L, Bottio T, Minutolo G, Thiene G, Casarotto D. Prosthetic replacement of the tricuspid valve: biological or mechanical? Ann Thorac Surg 1998; 66:S62-7. [PMID: 9930419 DOI: 10.1016/s0003-4975(98)01036-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Incidence of tricuspid prosthesis replacement was 1.9% of all valvular operations performed between June 6, 1966 and April 18, 1996. Many series report similar figures, but institutional experience is limited and the consensus on treatment modalities is lacking. METHODS One hundred tricuspid operations were performed on 83 patients (46 female). A primary operation was performed in 64 cases, 13 patients had one previous operation, 4 patients had two previous operations, and 2 patients had three previous operations. Seventeen patients required a tricuspid prosthetic valve rereplacement. There were 2 emergent and 17 urgent operations. The New York Heart Association class was IV in 13 patients (mean pulmonary artery pressure, 41 mm Hg), III in 66 patients (mean pressure, 38 mm Hg), and II in 21 patients. The most frequent operation was simultaneous replacement of the mitral and tricuspid valve (41 patients). Seventy biological and 30 mechanical prostheses were used. Total follow-up time was 613 years, mean 7.4 years (median 4.2 years), with a maximum of 27.8 years, and was 92% complete. RESULTS Operative mortality was 24%. Survival was 0.54 (0.48 to 0.59, n = 39) at 5 years, 0.38 (0.32 to 0.44, n = 27) at 10 years, 0.31 (0.25 to 0.36, n = 19) at 15 years, 0.29 (0.23 to 0.34, n = 11) at 20 years, and 0.17 (0.098 to 0.26, n = 3) at 25 years. Early mortality was increased from higher New York Heart Association class (hazard ratio = 2.2), congenital disease (hazard ratio = 6.9), and valvuloplasty failure (hazard ratio = 4.3). The constant risk phase (4%/patient-year) after 2 years was enhanced by older operative age (hazard ratio = 1.4). Prosthetic type had no independent effect. Biological prostheses were at risk for 300 years and had a reoperation incidence of 4.7%/ patient-year (14 events); mechanical prosthesis were at risk for 137 years with a rate of 2.2%/patient-year (3 events) (p = 0.21). Three valve thromboses were observed in old-design mechanical prosthesis. Bioprosthetic degeneration showed a steeper rate after 7 years. CONCLUSIONS This study does not show a clear superiority of biological versus mechanical prostheses. In the long run survival with mechanical prostheses could be superior, given the high rate of bioprosthetic degeneration after 7 years.
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Affiliation(s)
- G Rizzoli
- Division of Cardiac Surgery, University of Padova, Italy.
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Bajzer CT, Stewart WJ, Cosgrove DM, Azzam SJ, Arheart KL, Klein AL. Tricuspid valve surgery and intraoperative echocardiography: factors affecting survival, clinical outcome, and echocardiographic success. J Am Coll Cardiol 1998; 32:1023-31. [PMID: 9768728 DOI: 10.1016/s0735-1097(98)00355-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of echocardiographic-guided treatment on outcome after tricuspid valve (TV) surgery is not well defined. OBJECTIVES The purpose of this study was to determine clinical and echocardiographic factors associated with adverse outcomes after TV surgery and determine the role of intraoperative echo (IOE) in facilitating successful outcomes after TV surgery. METHODS Four hundred and one patients (279 females, mean age 60 years) underwent TV surgery and other concomitant cardiac surgery at a single institution and were followed clinically and by echocardiography during a 10-year period. RESULTS Decreased survival after TV surgery was associated with: preoperative increased New York Heart Association (NYHA) functional classification (relative risk [RR]=2.02), increased left ventricular dysfunction by echocardiography (RR=1.28), and use of a TV replacement strategy (RR=2.92). Decreased event-free survival after TV surgery was associated with concomitant coronary artery bypass grafting (RR=2.97). Late echocardiographic failure (3 to 4+ tricuspid valve regurgitation [TR]) after TV surgery was associated with increased severity of TR on preoperative echocardiogram (odds ratio [OR]=1.91). Decreased late echocardiographic failure after TV surgery was associated with the use of a TV annuloplasty ring with a repair strategy (OR=0.40). The surgical plan was altered at the time of surgery to insure a successful outcome in 32 (10%) of 335 patients based on IOE findings. CONCLUSIONS Adverse outcomes after TV surgery can be predicted by several preoperative clinical and echocardiographic variables. IOE is useful in improving immediate, but not late, outcomes after TV surgery.
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Affiliation(s)
- C T Bajzer
- Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44106-0001, USA
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Kuwaki K, Komatsu K, Morishita K, Tsukamoto M, Abe T. Long-term results of porcine bioprostheses in the tricuspid position. Surg Today 1998; 28:599-603. [PMID: 9681608 DOI: 10.1007/s005950050191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
From January 1976 to September 1994, 26 patients underwent a tricuspid valve replacement (TVR) with porcine bioprostheses (Hancock II in 19 patients, Carpentier-Edwards in 3, Hancock standard in 2, Medtronic-Intact in 1, and Liotta in 1). The mean age of these patients was 38.4 years (range, 9 to 70 years). The mean follow-up period was 6.7 years (range, 1.8 to 16.5 years). There was a complete follow-up in 100%. There were two hospital deaths and three late deaths. The actuarial survival rate at 16 years was 78.7%+/-8.6%. Five patients developed structural deterioration. Four of these 5 patients underwent re-TVR. The actuarial freedom rate from structural deterioration at 10 years was 47.1%+/-19.1%. There were no instances of thromboembolism and prosthetic valve endocarditis. Our experience indicated the major problem of the porcine bioprostheses in the tricuspid position thus to be valve durability: however, the long-term actuarial survival rate was satisfactory, including no operative morality with re-TVR due to tricuspid prosthetic structural deterioration. We therefore conclude that the choice of a porcine bioprosthesis in the tricuspid position should be considered not only for patients with isolated tricuspid valve disease, but also for the patients who have not previously received mechanical valves in the mitral or the aortic valve position.
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Affiliation(s)
- K Kuwaki
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Japan
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Fukada J, Morishita K, Komatsu K, Abe T. Influence of pulmonic position on durability of bioprosthetic heart valves. Ann Thorac Surg 1997; 64:1678-80; discussion 1680-1. [PMID: 9436554 DOI: 10.1016/s0003-4975(97)00852-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The insertion of bioprosthetic valves into the pulmonic position is not performed commonly because of uncertainty concerning the necessity and durability of such valves. METHODS We reviewed the long-term outcome of 10 patients who underwent pulmonary valve replacement with bioprostheses between March 1985 and March 1997. A Carpentier-Edwards supraannular bioprosthesis was used in 7 patients, a Hancock II bioprosthesis was used in 2 patients, and a Carpentier-Edwards pericardial bioprosthesis was used in 1 patient. The mean patient age at the time of pulmonary valve replacement was 38.9 +/- 16.3 years (range, 15 to 63 years). The diagnoses were pulmonary valvular regurgitation after corrective surgery for tetralogy of Fallot in 7 patients, right ventricular outflow tract stenosis and absent right pulmonary artery combined with a double-outlet right ventricle in 1 patient, pulmonary valvular regurgitation with pulmonary artery dilatation in 1 patient, and aortic valve stenosis treated with our modification of the Ross procedure using a pulmonary bioprosthesis in 1 patient. Survivors were followed up for a mean of 5 years and 5 months. RESULTS One patient underwent reoperation because of infective endocarditis of the bioprosthesis. No bioprosthetic valve dysfunction has been observed on Doppler echocardiography during a maximum follow-up period of 12.2 years, except in the patient who underwent replacement at 15 years of age. CONCLUSIONS Bioprostheses in the pulmonic position are durable in adult patients because they face a minimal hemodynamic load, but they may undergo early leaflet degeneration in younger patients.
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Affiliation(s)
- J Fukada
- Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
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