Fifteen-Year Outcomes After Bioprosthetic and Mechanical Tricuspid Valve Replacement

Abstract

Background. This study was conducted to compare long-term clinical outcomes of mechanical and bioprosthetic tricuspid valve replacement (TVR). Methods. Two-hundred twenty-six TVR patients were enrolled; 120 patients underwent bioprosthetic TVR (BTV group) and 106 underwent mechanical TVR (MTV group). Early results and long-term clinical outcomes were compared. The median follow-up duration was 99 months (range, 1-295). Propensity score (PS) analyses including PS-adjusted Cox regression models and 1:1 PS matching were performed. Results. Mean ages of the MTV and BTV groups were 50.5 +/- 10.3 and 60.8 +/- 12.0 years, respectively. There were no significant differences in early mortality (4.9% in total) and postoperative complications between the 2 groups. The overall survival and freedom from cardiac death in the MTV group were similar to those in the BTV group (reference, BTV group; hazard ratio [HR], 0.82 [95% confidence interval {CI}, 0.44-1.53] and 0.91 [95% CI, 0.44- 1.87], respectively). The risk of a composite of thromboembolism and bleeding was significantly higher in the MTV group (HR, 2.35; 95% CI, 1.16-4.77; P = .018). However the tricuspid valve reoperation rate was significantly lower in the MTV group (HR, 0.11; 95% CI, 0.02-0.53; P = .007). Overall TV-related event rates in the MTV group were similar to those in the BTV group (HR, 0.79; 95% CI, 0.49-1.28). PS matching extracted 69 pairs. Comparative analyses of early- and long-term outcomes from the matched groups yielded similar findings to those from the entire patient groups. Conclusions. The outcomes of bioprosthetic TVR were comparable with those of mechanical TVR in terms of long-term survival and tricuspid valve-related events over a 15-year postoperative follow-up. (C) 2020 by The Society of Thoracic Surgeons