Clinical Outcomes of the Tricuspid Valve Replacement at Our Clinic
- VernacularTitle:当院における三尖弁置換術の成績
- Author:
Yuichiro YOKOYAMA
1
;
Takeshi EMMOTO
1
Author Information
- Keywords: tricuspid valve replacement; Carpentier-Edwards pericardial valve; tissue valve
- From:Japanese Journal of Cardiovascular Surgery 2024;53(4):169-173
- CountryJapan
- Language:Japanese
- Abstract: Background: Residual tricuspid regurgitation has recently been recognized as an adverse prognostic factor, for which reliable regurgitation control is required. Tricuspid valve repair with ring annuloplasty is the most common procedure for tricuspid regurgitation. However, if the rings are severely enlarged or the valves are strongly tethered by enlarged right ventricles, it is difficult to control the regurgitation by annuloplasty procedure only. The complex valvuloplasty procedures as required for mitral valve surgery are sometimes needed for these severe cases. Although tricuspid valve replacement (TVR) is sometimes chosen for simple and reliable regurgitation control in such cases, the procedure is uncommon and the long-term outcomes have yet to be clearly identified. In this study, the results of 17 TVR cases at our clinic are reviewed. Patients and Methods: Seventeen patients underwent TVR between February 2008 and May 2022. The operative outcomes and the echocardiographic changes of the implanted prosthetic valves were then retrospectively studied. Results: All the patients had implanted Carpentier-Edwards pericardial valves. Hospital mortality occurred in two cases. Among the survivors, three patients underwent re-operations for prosthetic valve dysfunction. One patient underwent tricuspid valvuloplasty using the Inoue balloon catheter, while the other two underwent re-tricuspid valve replacement using prosthetic tissue valves. The explanted valves showed severe adhesion between the leaflets and around the tissue, such as the patient's own remaining tricuspid valves or the right ventricular organs. The timings of the re-operations were 6 to 8 years after the first TVR. Prosthetic valve function was studied by color Doppler echocardiography. Follow-up data were available only for twelve patients. Prosthetic valve regurgitation steadily worsened approximately three years after the operation, and the mean transprosthetic gradient gradually increased about 1.5 times in four years after implantation. These results suggest that the Carpentier-Edwards pericardial valve in the tricuspid position may begin to deteriorate in 3 to 4 years. Conclusion: The surgical outcomes of TVR with the Carpentier-Edwards pericardial valves are not satisfactory.
