Long-term results of bioprosthetic tricuspid valve replacement: an analysis of 25 years of experience

Background Current knowledge in long-term results of tricuspid valve replacement is limited. Present study reviews our experience from a consecutive series. Methods We retrospectively studied the early and late results of 32 consecutive patients (7 male and 25 female; mean age 60.2 +/- 18.1 years) undergoing bioprosthetic tricuspid valve replacement between 1985 and 2010. The etiology is rheumatic in 38 %, congenital in 3 %, endocarditis in 9 %, and functional in 50 %. Patients underwent isolated valve replacement. The remaining underwent combined aortic and tricuspid (n = 5, 16 %), mitral tricuspid (n = 15, 47 %), and aortic, mitral, and tricuspid (n = 1, 3 %) valve replacement. Preoperative liver dysfunction was evaluated using Model for End-stage Liver Disease (MELD) score. Mean follow-up was 5.6 +/- 6.8 years (ranging from 0 to 25.0 years). Results Hospital mortality was 19 %. On univariate logistic regression analysis, NYHA class IV (p = 0.039, odds ratio 11.3, 95 % confidence interval 1.2-112.5), MELD score ([10) (p = 0.011, odds ratio 21.0, 95 % confidence interval 12.0-222.0) and congestive liver (p = 0.05, odds ratio 9.4, 95 % confidence interval 1.0-93.5) were incremental risk factors for hospital death. The 15-and 25-year actuarial survival were 56.5 +/- 10.3 % and 45 +/- 13.0 %, respectively. Multivariate analysis using Cox proportional hazard model showed MELD score (p = 0.024, hazard ratio 7.0, 95 % confidence interval 2.1-23.9) and postoperative pulmonary hypertension (p = 0.012, hazard ratio 4.4, 95 % confidence interval 1.4-14.1) were significantly associated with decreased survival. At 15 years, freedom rates from tricuspid valve reoperation, anticoagulation-related bleeding, and valve related events were 85.7 +/- 13.2 %, 95.7 +/- 4.3 % and 81.8 +/- 13.2 %, respectively. The linearized incidence of structural valve deterioration was 0.50 %/patient-year, anticoagulation-related bleeding was 0.94 %/patient-year, and valve-related events were 1.52 %/patient-year. Conclusion Preoperative hepatic congestion and liver dysfunction which were indicated by the MELD score[ 10 were associated with poor outcome for patients undergoing tricuspid valve replacement. The MELD score is useful to predict the morality among these patients.