Propensity score matching analysis of mechanical versus bioprosthetic tricuspid valve replacements.

BACKGROUND

Evidence for optimal prosthesis in the tricuspid position is lacking. We compared long-term results of tricuspid valve replacement (TVR) using mechanical and bioprosthetic valves.

METHODS

From January 1994 to December 2012, 224 patients (male to female ratio=55:169) underwent TVR. Mechanical TVR was performed in 121 patients (MTV group), and 103 patients underwent bioprosthetic TVR (BTV group). Patients in the BTV group were older and more frequently had hypertension than those in the MTV group. Propensity score matching was performed, and 66 patients were extracted from each group. Median follow-up duration was 73 (1 to 235) months. Operative results, long-term survival, and tricuspid valve-related events (TVRE) were compared.

RESULTS

The ages of the propensity score-matched patients were 54.1±8.7 and 55.3±11.6 years in the MTV and BTV groups, respectively. Early mortality (n=9, 6.8%) and postoperative complications were similar between the propensity score-matched groups. The 10-year overall survival and freedom from cardiac death rates were similar between the 2 matched groups (p=0.897 and p=0.893, respectively). Freedom rates from a composite of thromboembolism and bleeding were lower in the MTV group than in the BTV group (83.6% and 77.4% vs 89.5% and 89.5% at 5 and 10 years, respectively), although it was not statistically significant. The TVRE-free rates at 10 years were 54.8% and 53.6% in the MTV and BTV groups, respectively.

CONCLUSIONS

Bioprosthetic valve replacement is a valid option for TVR in these relatively young patients because anticoagulation could be avoided without increasing the risks of long-term TVRE.