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.