Long-term outcomes after bioprosthetic tricuspid valve replacement: a multicenter study
Antonio Piperata, Jef Van Den Eynde, Mateo-Marin Cuartas, Giacomo Bortolussi, Petr Fila, Tim Walter, Mehmet Cahit Sarıcaoğlu, Jan Gofus, Bilkhu Rajdeep, Michel Pompeu Sá, Fabrizio Rosati, Manuela De La Cuestac, Elisa Gastino, Besart Cuko, Julien Ternacle, Carlo de Vincentiisd, Martin Czerny, Ahmet Rüçhan Akar, Gianluca Lucchese, Basel Ramlawi, Michael Borger, Thomas ModineAbstract
OBJECTIVES
Long-term evidence about bioprosthetic tricuspid valve replacement is scarce. This study aims to investigate the long-term clinical outcomes of patients who underwent tricuspid valve replacement with bioprostheses.
METHODS
This multicentre retrospective study included patients from 10 high-volume centres in 7 different countries, who underwent tricuspid valve replacement with bioprostheses. Echocardiographic and clinical data were reviewed. Long-term outcomes were investigated using Kaplan–Meier estimates, Cox regression, and competing risk analysis.
RESULTS
Of 675 patients, isolated tricuspid valve replacement was performed in 358 patients (53%), while 317 (47%) underwent concomitant procedures. Between these two groups, patients underwent combined procedures reported a significant higher incidence of infection, atrioventricular block, multi organ failure, longer ICU and hospital stay and higher 30-day mortality over patients underwent isolated procedure. The overall 30-day mortality occurred in 70 patients (10.4%) [46 (14.6%) combined Vs 24 (6.74%) isolated, p = 0.001]. During the follow-up there was a continuous rate of attrition due to death, with cumulative incidences of death at 5,10, and 15 years being 27.2%,46.2%, and 60.6%, respectively. In contrast, the risk of reintervention starts to significantly increase after 10 years of follow-up, with cumulative incidences of reintervention being 6.1%, 10.8%, and 23.3% respectively. Freedom from tricuspid valve reintervention, pacemaker implantation, tricuspid valve endocarditis, and major thromboembolic events at 15 years were 56.5%,77.3%,84.0%, and 86.4%, respectively.
CONCLUSIONS
Tricuspid valve replacement with bioprostheses is an effective treatment for valvular disease, despite being associated with relatively high early and long-term mortality. However, the risk of structural valve degeneration rises significantly after 10 years.