Native valve attachment to the prosthetic valve 2.5 years after the 3rd tricuspid valve replacement

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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Long-term results of tricuspid valve replacement and the problem of prosthetic valve thrombosis

The American Journal of Cardiology ◽

10.1016/0002-9149(83)90357-0 ◽

1983 ◽

Vol 51 (7) ◽

pp. 1128-1132 ◽

Cited By ~ 117

Author(s):

Charles W. Thorburn ◽

John J. Morgan ◽

Mark X. Shanahan ◽

Victor P. Chang

Keyword(s):

Valve Replacement ◽

Tricuspid Valve ◽

Prosthetic Valve ◽

Long Term Results ◽

Tricuspid Valve Replacement ◽

Prosthetic Valve Thrombosis ◽

Valve Thrombosis

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Tricuspid Valve Infective Endocarditis In Drug Abusers: Clinical Features and Results of Surgical Treatment

Nepalese Heart Journal ◽

10.3126/njh.v7i1.8499 ◽

2013 ◽

Vol 7 (1) ◽

pp. 29-34

Author(s):

DI Lashmanov ◽

Krishna Bhandari ◽

VA Chiginev ◽

VV Pichugin ◽

EN Zemskova

Keyword(s):

Surgical Treatment ◽

Drug Abuse ◽

Infective Endocarditis ◽

Valve Replacement ◽

Clinical Features ◽

Tricuspid Valve ◽

Prosthetic Valve ◽

Drug Abusers ◽

Tricuspid Valve Replacement ◽

Ultrasound Investigation

The objective of this study was to evaluate the clinical features, diagnostic criteria and indications for surgery in patients – drug abusers with tricuspid valve infective endocarditis (TVIE), and outcome of surgical treatment in these patients. From December 1999 to August 2009 35 patients (drug addicts) with TVIE were operated in the department of acquired heart diseases of Cardiac and Vascular Surgery Center, Nizhny Novgorod. 25 males and 10 females aged from 15 to 51 years were included in this study. 3 patients were re-operated due to recurrence of endocarditis. Biological prosthetic valve "Bio-Lab" was used in all patients. Intravenous drug abuse was the cause of the disease in all patients. Acute onset with hectic fever, shivering, profuse sweating, intoxication and development of multi-organ failure were the main clinical features of the disease. Embolism of the peripheral branches of pulmonary artery by septic embolus or micro thrombi were common symptoms. Ultrasound investigation played an important role in diagnosis of TVIE. It was the only criteria for the verification of the diagnosis in patients with fever of unknown origin until the appearance of valve damages and cardiac murmurs. All 35 (100%) patients underwent tricuspid valve replacement (TVR). 3 (8.57%) patients underwent redo TVR because of prosthetic valve endocarditis due to persistent intravenous drug abuse after surgery. The hospital mortality rate was 0%. Acute debut of the disease may be the first clinical feature of tricuspid valve infective endocarditis in drug abusers. Ultrasound investigation is important for early diagnosis and effective treatment. Surgical treatment is indicated in cases of ineffective antibiotic therapy and massive tricuspid valve damages. Tricuspid valve replacement by a biological prosthesis was the treatment of choice in these patients. The use of biological prosthetic valve had good clinical results with low thrombogenic risk and high resistance to infection. Nepalese Heart Journal | Volume 7 | No.1 | November 2010 (special issue) | Page 29-34 DOI: http://dx.doi.org/10.3126/njh.v7i1.8499

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Complete Prosthetic Valve Thrombosis Despite Several Thrombolytic Treatments after Tricuspid Valve Replacement

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-1013855 ◽

1993 ◽

Vol 41 (03) ◽

pp. 199-201 ◽

Cited By ~ 4

Author(s):

M. Cottogni ◽

H. Antretter ◽

W. Furtwängler

Keyword(s):

Valve Replacement ◽

Tricuspid Valve ◽

Prosthetic Valve ◽

Tricuspid Valve Replacement ◽

Prosthetic Valve Thrombosis ◽

Valve Thrombosis

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Tricuspid Valve Replacement: Mechanical or Biological Prostheses? A Systematic Review and Meta-Analysis

The Heart Surgery Forum ◽

10.1532/hsf.3531 ◽

2021 ◽

Vol 24 (2) ◽

pp. E209-E214

Author(s):

Zeyi Cheng ◽

Tingting Fang ◽

Dandan Wang ◽

Yingqiang Guo

Keyword(s):

Valve Replacement ◽

Tricuspid Valve ◽

Prosthetic Valve ◽

Meta Analysis ◽

Early Mortality ◽

Tricuspid Valve Replacement ◽

Mechanical Prostheses ◽

Significant Difference ◽

Valve Position ◽

Biological Prostheses

Background: Tricuspid valve replacement (TVR) is seldom performed in cardiac valve surgery, and there currently are no clinical guidelines as to which type of prostheses is better in tricuspid valve position. This meta-analysis was performed to compare the results of mechanical and biological prostheses for TVR. Methods: We searched the Pubmed, Cochrane, and Embase clinical trial databases to collect all related studies published from January 1, 2000 to July 31, 2020. A random-effects model was used to evaluate the odds ratios (OR) and its 95% confidence intervals (CI) of time-to-event related effects of the surgical procedures; every study’s quality was evaluated by the Newcastle-Ottawa Scale (NOS). Results: A total of 13 retrospective studies, including 1453 patients were analyzed. There were no statistically differences between mechanical and biological prostheses with respect to prosthetic valve failure [OR = 0.84, 95% CI(0.54, 1.28), P = .41], bleeding [OR = 0.84, 95% CI(0.54,1.28), P = .41], reoperation [OR = 1.02, 95% CI(0.58,1.78), P = .95], early mortality [OR = 1.35, 95% CI(0.82,2.25), P = .24] and long-time survival [OR = 1.09, 95% CI(0.70, 1.69), P = .70], but a significant difference can be seen in mechanical prostheses with a higher risk of thrombosis [OR = 0.17, 95% CI(0.05, 0.60), P = .006, I2 = 0%]. Conclusions: In tricuspid valve position, mechanical valve prostheses have a higher risk of thrombosis than biological prostheses, but no statistical differences between mechanical and biological prostheses with respect to prosthetic valve failure, bleeding, reoperation, early mortality, and long-term survival. The valve disease and patient’s age and risk factors are the most important considerations in the decision-making process. The more specific conclusion needs to be further proved by large-sample, multi-center, randomized, double-blind and control trials.

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